{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:12:44Z","timestamp":1789560764887,"version":"build-2803163510"},"reference-count":11,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,31]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) share overlapping clinical features, making early distinction difficult, especially in antineutrophil cytoplasmic antibody (ANCA)-negative disease where eosinophil-mediated injury may precede vasculitis. We report a male patient in his mid-20s who initially presented with fever, purpuric rash, neuropathy, marked eosinophilia, hepatic dysfunction and extensive multisystem thrombosis. Biopsy revealed eosinophilic infiltration without vasculitis, supporting a diagnosis of HES. He achieved remission on corticosteroids and anticoagulation but relapsed 5 years later with recurrent thrombosis, purpura, eosinophilia and biopsy-proven eosinophilic vasculitis, prompting reclassification as ANCA-negative EGPA. Treatment with corticosteroids, rituximab and anticoagulation resulted in sustained remission over 36 months. This case highlights the diagnostic continuum between HES and EGPA and the need for long-term follow-up with reassessment of diagnosis. Early recognition of evolving vasculitis is essential to guide appropriate immunosuppressive therapy.<\/jats:p>","DOI":"10.1136\/bcr-2026-273616","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:00:22Z","timestamp":1789560022000},"page":"e273616","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["D\u00e9j\u00e0 vu"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5586-1141","authenticated-orcid":false,"given":"Aashish Omprakash","family":"Agrawal","sequence":"first","affiliation":[{"name":"Rheumatology, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditi Sanjiv","family":"Patankar","sequence":"additional","affiliation":[{"name":"Rheumatology, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Samant","sequence":"additional","affiliation":[{"name":"Rheumatology, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"2026091605001035000_19.9.e273616.1","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.jaci.2023.03.011","article-title":"Unmet needs and evidence gaps in hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis","volume":"151","author":"Wechsler","year":"2023","journal-title":"J Allergy Clin Immunol"},{"key":"2026091605001035000_19.9.e273616.2","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.mayocp.2023.02.013","article-title":"HES and EGPA: Two Sides of the Same Coin","volume":"98","author":"Khoury","year":"2023","journal-title":"Mayo Clin Proc"},{"key":"2026091605001035000_19.9.e273616.3","doi-asserted-by":"crossref","first-page":"i92","DOI":"10.1093\/rheumatology\/keae608","article-title":"Highlights from the plenary session: eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome","volume":"64","author":"Holle","year":"2025","journal-title":"Rheumatology (Oxford)"},{"key":"2026091605001035000_19.9.e273616.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223764"},{"key":"2026091605001035000_19.9.e273616.5","doi-asserted-by":"crossref","first-page":"4470","DOI":"10.1093\/rheumatology\/keaf240","article-title":"The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis","volume":"64","author":"Biddle","year":"2025","journal-title":"Rheumatology (Oxford)"},{"key":"2026091605001035000_19.9.e273616.6","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1002\/art.41773","article-title":"2021 American College of Rheumatology\/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis","volume":"73","author":"Chung","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"2026091605001035000_19.9.e273616.7","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-85852-9","article-title":"Venous thrombosis and predictors of relapse in eosinophil-related diseases","volume":"11","author":"R\u00e9au","year":"2021","journal-title":"Sci Rep"},{"key":"2026091605001035000_19.9.e273616.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12969-024-01054-3","article-title":"Massive pulmonary thromboembolism in a pediatric patient with eosinophilic granulomatosis with polyangiitis: a case-based review emphasizing management","volume":"23","author":"K\u00fc\u00e7\u00fckali","year":"2025","journal-title":"Pediatr Rheumatol Online J"},{"key":"2026091605001035000_19.9.e273616.9","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu427"},{"key":"2026091605001035000_19.9.e273616.10","doi-asserted-by":"crossref","unstructured":"Fijolek J , Radzikowska E . Eosinophilic granulomatosis with polyangiitis \u2013 Advances in pathogenesis, diagnosis, and treatment. Front Med 2023;10. doi:10.3389\/fmed.2023.1145257","DOI":"10.3389\/fmed.2023.1145257"},{"key":"2026091605001035000_19.9.e273616.11","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221794"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273616","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:00:25Z","timestamp":1789560025000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":11,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,16]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-273616"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273616","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}