Bilateral diaphragmatic paralysis as clinical onset of eosinophilic granulomatosis with polyangiitis: A case report

Eosinophilic granulomatosis with polyangiitis is a rare small-vessel vasculitis that may affect different organs, leading to a highly variable and often challenging initial clinical presentation. We report the case of a 67-year-old man presenting with acute non-exertional dyspnoea and chest tightness. He had a history of adult-onset asthma, chronic rhinosinusitis and peripheral eosinophilia. Imaging revealed bilateral diaphragmatic elevation, and needle electromyography confirmed diaphragmatic paralysis. His medical history, combined with the presence of an eosinophilic exudative pleural effusion, transient pulmonary ground-glass opacities, and turbinate eosinophilic extravascular inflammation led us to a diagnosis of eosinophilic granulomatosis with polyangiitis characterised by bilateral diaphragmatic paralysis. Eosinophilic granulomatosis with polyangiitis should be considered in patients with unexplained diaphragmatic paralysis associated with an appropriate clinical and laboratory picture, as prompt recognition is crucial for the prognosis.