Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Nasal Obstruction

A 55-year-old man presented with high-grade fever, nasal obstruction, and erythematous skin rash for 1 week. He had hypertension for 5 years, uncontrolled diabetes mellitus for 6 years, and bronchial asthma for the past 8 years. He was diagnosed to have eosinophilic granulomatosis with polyangiitis (EGPA) based on the clinical, laboratory, and histopathological findings. He was treated with prednisolone 1 mg/kg which was tapered over months. He had immediate relief for his nasal obstruction following steroids. Fever and skin rash subsided later. We present a patient with acute nasal obstruction during the vasculitic phase of EGPA. Nasal manifestations are usually seen during the early phase along with asthma long before the onset of vasculitic phase. Invasive fungal infections of the paranasal sinuses which can have similar presentations also should be ruled out by histopathology in such patients, especially when they are at risk. Awareness regarding such rare acute presentations of an uncommon vasculitis can avoid diagnostic dilemmas.