Eosinophilic Granulomatosis with Polyangiitis presenting as Vasculitis in the Temporal Artery

A 59-year-old man presented to the Emergency Department with vision disturbance, presenting concurrently bronchial asthma and pansinusitis, with complete blood count showing marked eosinophilia (32,420/mL at 79% of white blood cells). Clinical, laboratory, and imaging investigations were unremarkable except for persisting eosinophilia. A histological examination of a biopsied temporal artery showed vasculitis in the temporal artery and concomitant granulomatous inflammation, with lymphocytes, eosinophils, and multinucleated giant cells. Based on the biopsy and a positive anti-myeloperoxidase antibody (anti-MPO/p-ANCA) result, a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) was made. The patient was initially treated with methylprednisolone pulses and recovered vision. We consider the present case as EGPA manifesting as temporal arteritis with vision loss and treated it as such, with the patient making a full recovery without further symptomatology occurrences. The current case underlines how ANCA-associated vasculitides can rarely manifest in the form of temporal arteritis.