Abstract: FR-PO0783
ANCA-Negative Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Abdomen with Renal Involvement: A Diagnostic Challenge
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Salazar-Alejo, Misael, Tecnologico de Monterrey, Monterrey, N.L., Mexico
- Riojas, Valeria, Tecnologico de Monterrey, Monterrey, N.L., Mexico
- Garza González, Ana Sofía, Tecnologico de Monterrey, Monterrey, N.L., Mexico
- Navarrete, Claudia Aline, Tecnologico de Monterrey, Monterrey, N.L., Mexico
- Maya-Quinta, Rogelio, Tecnologico de Monterrey, Monterrey, N.L., Mexico
Introduction
Compared with other ANCA-associated vasculitides (AAV), renal involvement occurs in only ~25% of EGPA patients, whereas gastrointestinal manifestations are more common, affecting 24–78% of patients. Due to its heterogeneous clinical presentation and potential for multi-organ involvement, both diagnosis and management of EGPA pose significant challenges.
Case Description
A 64-year-old male presented with a 3-day history of malaise, fever, nausea, and diffuse abdominal pain. Physical examination revealed abdominal tenderness. Non-contrast CT demonstrated bilateral discrete perirenal fat stranding and initial labs showed marked leukocytosis. Upon further questioning, the patient reported a 6-month history of nasal congestion and dyspepsia. Subsequent lab results revealed neutrophilia, eosinophilia, subnephrotic-range proteinuria, and leukoerythrocyturia. Upper endoscopy with biopsy revealed gastritis with eosinophilic infiltration of the gastric mucosa. Immunologic workup demonstrated low C3/C4, and negative ANA, PR3, and MPO Abs. Given the constellation of findings, kidney biopsy was performed, demonstrating proliferative mesangial glomerulonephritis with eosinophilic infiltration. In light of the multi-organ involvement, including GI manifestations, treatment was initiated with systemic corticosteroids and mepolizumab. The patient demonstrated a favorable clinical response with symptom resolution and normalization of eosinophil count.
Discussion
Renal involvement in EGPA is remarkably heterogeneous and represents an adverse prognostic factor. This underscores the importance of renal biopsy for both confirmation and characterization of specific kidney pathology. Contemporary management strategies incorporate glucocorticoids, conventional immunosuppressants, and targeted biologic therapies.