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A 64-year-old man with type 2 diabetes, chronic kidney disease, and asthma developed systemic symptoms, mononeuritis multiplex, and pulmonary hemorrhage. Marked eosinophilia and MPO-ANCA positivity, with asymmetric axonal neuropathy on electrophysiology, supported EGPA. Multidisciplinary evaluation confirmed the diagnosis, and treatment with corticosteroids, cyclophosphamide, plasmapheresis, and rituximab produced significant clinical improvement, underscoring early recognition to prevent irreversible organ damage.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/eosinophilic-granulomatosis-with-polyangiitis-presenting-as-mononeuritis-multiplex-in-a-diabetic-patient-diagnostic-and-therapeutic-challenges/408010/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/eosinophilic-granulomatosis-with-polyangiitis-presenting-as-mononeuritis-multiplex-in-a-diabetic-patient-diagnostic-and-therapeutic-challenges/408010.png","ImageObject",300,407,{"name":42,"@type":43},"Aldword","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What makes EGPA-related neuropathy difficult to diagnose in diabetic patients?","Question",{"text":63,"@type":64},"Diabetic neuropathy is usually distal and symmetric, while vasculitic neuropathy is often asymmetric and patchy and may include systemic features, so the presentation can be confusing.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What clinical and laboratory findings supported EGPA in this case?",{"text":68,"@type":64},"Marked eosinophilia and strongly positive MPO-ANCA were present, and electrophysiology showed asymmetric axonal neuropathy.",{"name":70,"@type":61,"acceptedAnswer":71},"Which treatments were used and what was the outcome?",{"text":72,"@type":64},"The patient received corticosteroids, cyclophosphamide, plasmapheresis, and rituximab, leading to significant clinical 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\nAhmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98219  \nOpen Access Case Report  \nEosinophilic Granulomatosis With Polyangiitis Presenting as Mononeuritis Multiplex in a Diabetic Patient: Diagnostic and Therapeutic Challenges  \nWaqas Ahmed 1, Muhammad Zeeshan Khan 2 , Rameen Saeed 3, Kamran Nazir 4, Muhammad Farooq 5  \n1. Respiratory Medicine, Lancashire Teaching Hospital, Chorley, GBR 2. Acute Medicine, Aintree University Hospital, Liverpool, GBR 3. Internal Medicine, Farooq Hospital, Lahore, PAK 4. Medicine, Lancashire Teaching Hospital, Chorley, GBR 5. Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR  \nCorresponding author: Waqas Ahmed, [drwikki@yahoo.com](drwikki@yahoo.com)  \nAbstract  \nEosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody (ANCA) -associated small-vessel vasculitis that may present with asthma, eosinophilia, pulmonary involvement, and peripheral neuropathy. Distinguishing EGPA-related vasculitic neuropathy from diabetic neuropathy can be particularly challenging in patients with long-standing diabetes mellitus. We present a case of a 64-year-oldman with type 2 diabetes, chronic kidney disease, and asthma, who developed systemic symptoms, mononeuritis multiplex, and pulmonary haemorrhage. Laboratory tests revealed marked eosinophilia and strongly positive myeloperoxidase (MPO)-ANCA, while electrophysiological studies demonstrated asymmetric axonal neuropathy. A multidisciplinary assessment by neurology and rheumatology confirmed the diagnosis of EGPA with vasculitic neuropathy, following which treatment with corticosteroids, cyclophosphamide, plasmapheresis, and rituximab resulted in significant clinical improvement. This case highlights the importance of recognizing atypical or asymmetric neuropathies in diabetic patients and considering EGPA early to prevent irreversible organ damage.  \nCategories: Neurology, Nephrology, Allergy/Immunology  \nKeywords: diabetic peripheral neuropathy (dpn), drop-foot, eosinophilic granulomatosis with polyangiitis (egpa), plasmapheresis treatment, pulmonary hemorrhage  \nIntroduction  \nEosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome, is a rare antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis that causes eosinophilic tissue infiltration and extravascular granulomas and can affect multiple organ systems, most commonly the lungs and peripheral nerves and, less frequently, the kidneys and heart [1,2] . EGPA typically progresses through three overlapping phases: a prodromal phase with asthma and allergic rhinitis, an eosinophilic phase characterized by tissue infiltration, and a vasculitic phase involving systemic small vessels [3] . Peripheral neuropathy occurs in up to 75% of patients, most commonly manifesting as painful, asymmetric mononeuritis multiplex [4] . Diagnosing EGPA in patients with diabetes mellitus presents a particular challenge. Diabetic neuropathy typically presents as a distal symmetric polyneuropathy, whereas vasculiticneuropathy is asymmetric, patchy, and may be accompanied by systemic features [5-7]. Electrophysiological studies, serologic testing (myeloperoxidase (MPO)-ANCA/perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)) [6], and careful clinical evaluation are critical for accurate differentiation. Early recognition is essential to initiate immunosuppressive therapy like rituximab and prevent irreversible organ damage [8] .  \nCase Presentation  \nA 64-year-old man with type 2 diabetes mellitus, stage 3 chronic kidney disease, and asthma initially presented to his general practitione","cbCaitffXcRAuJAT","https://ap.wps.com/l/cbCaitffXcRAuJAT","pdf",2049008,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"What makes EGPA-related neuropathy difficult to diagnose in diabetic patients?\",\"answer\":\"Diabetic neuropathy is usually distal and symmetric, while vasculitic neuropathy is often asymmetric and patchy and may include systemic features, so the presentation can be confusing.\"},{\"question\":\"What clinical and laboratory findings supported EGPA in this case?\",\"answer\":\"Marked eosinophilia and strongly positive MPO-ANCA were present, and electrophysiology showed asymmetric axonal neuropathy.\"},{\"question\":\"Which treatments were used and what was the outcome?\",\"answer\":\"The patient received corticosteroids, cyclophosphamide, plasmapheresis, and rituximab, leading to significant clinical improvement.\"}]","Eosinophilic Granulomatosis With Polyangiitis Presenting as Mononeuritis Multiplex in a Diabetic Patient - Diagnostic and Therapeutic Challenges | PDF",1790577655]