{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:38:46Z","timestamp":1774607926324,"version":"3.50.1"},"reference-count":13,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,6,19]]},"published-print":{"date-parts":[[2019,7,9]]},"abstract":"<jats:p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic small-vessel vasculitic disease that can present with positive MPO-P-ANCA (myeloperoxidase\u2013perinuclear\u2013anti-neutrophil cytoplasmic antibody). It is a rare condition that is difficult to diagnose. We present the case of a 64-year-old man with late-onset adult asthma and treated nasopharyngeal carcinoma who initially presented to us with proximal myopathy. Thereafter, he developed a constellation of fleeting symptoms which included rhinosinusitis, mononeuritis multiplex, skin vasculitis and arthritis. Blood investigations showed that he had eosinophilia, and skin biopsy demonstrated dermal vasculitis with eosinophils. He was found to be MPO-C-ANCA positive, and although initially thought to have granulomatosis with polyangiitis, the diagnosis was later revised to EGPA. This case highlights the diagnostic challenges with atypical presentations of EGPA and also presents a rare case of positive MPO-C-ANCA that has never been described in EGPA before.<\/jats:p>","DOI":"10.1136\/bcr-2018-228621","type":"journal-article","created":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T05:45:15Z","timestamp":1562823915000},"page":"e228621","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["A challenging diagnosis of MPO-C-ANCA EGPA"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3589-7105","authenticated-orcid":false,"given":"Gareth","family":"Lim","sequence":"first","affiliation":[{"name":"Internal Medicine, Khoo Teck Puat Hospital, National Healthcare Group, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheryl","family":"Lim","sequence":"additional","affiliation":[{"name":"Internal Medicine, Khoo Teck Puat Hospital, National Healthcare Group, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shang-Ian","family":"Tee","sequence":"additional","affiliation":[{"name":"Dermatology, National Skin Centre, Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chai Yiing","family":"Ling","sequence":"additional","affiliation":[{"name":"Rheumatology, Khoo Teck Puat Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,10]]},"reference":[{"key":"2025082801581787000_12.7.e228621.1","doi-asserted-by":"publisher","DOI":"10.3109\/14397595.2013.857582"},{"key":"2025082801581787000_12.7.e228621.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.04.022"},{"key":"2025082801581787000_12.7.e228621.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780330806"},{"key":"2025082801581787000_12.7.e228621.4","doi-asserted-by":"publisher","DOI":"10.1002\/art.21250"},{"key":"2025082801581787000_12.7.e228621.5","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1056\/NEJM199711203372106","article-title":"Small-Vessel Vasculitis","volume":"337","author":"Jennette","year":"1997","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082801581787000_12.7.e228621.6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/s12890-018-0733-2","article-title":"A rare case report of polyangiitis overlap syndrome: granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis","volume":"18","author":"Quan","year":"2018","journal-title":"BMC Pulm Med"},{"key":"2025082801581787000_12.7.e228621.7","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1471-2474-15-388","article-title":"Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) presenting as diffuse myositis","volume":"15","author":"Parent","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"2025082801581787000_12.7.e228621.8","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201589"},{"key":"2025082801581787000_12.7.e228621.9","doi-asserted-by":"crossref","unstructured":"Oiwa H . Muscle weakness as a presenting symptom in ANCA-associated vasculitis. 2018;5:139\u201341.","DOI":"10.5152\/eurjrheum.2017.17067"},{"key":"2025082801581787000_12.7.e228621.10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s13317-010-0007-3","article-title":"Twenty-eight years with antineutrophil cytoplasmic antibodies (ANCA): how to test for ANCA - evidence-based immunology?","volume":"1","author":"Csernok","year":"2010","journal-title":"Auto Immun Highlights"},{"key":"2025082801581787000_12.7.e228621.11","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/j.1365-2249.1994.tb06051.x","article-title":"Some patients with anti-myeloperoxidase autoantibodies have a C-ANCA pattern","volume":"96","author":"Segelmark","year":"1994","journal-title":"Clin Exp Immunol"},{"key":"2025082801581787000_12.7.e228621.12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/0974-2727.66707","article-title":"Myeloperoxidase-antineutrophil Cytoplasmic Antibodies with Cytoplasmic Fluorescence Pattern","volume":"2","author":"Chhabra","year":"2010","journal-title":"J Lab Physicians"},{"key":"2025082801581787000_12.7.e228621.13","doi-asserted-by":"crossref","first-page":"205427041769271","DOI":"10.1177\/2054270417692710","article-title":"MPO-C-ANCA-associated necrotising and crescentic glomerulonephritis","volume":"8","author":"Koratala","year":"2017","journal-title":"JRSM Open"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:58:29Z","timestamp":1756371509000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,9]]},"references-count":13,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7,10]]},"published-print":{"date-parts":[[2019,7,9]]}},"alternative-id":["10.1136\/bcr-2018-228621"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228621","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,9]]}}}