Rare case of isolated eosinophilic granulomatosis with polyangiitis masquerading as asthma in a patient with vaping history: A case report

Pediatric Eosinophilic Granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is one of the rarest systemic vasculitides that is documented. 1 More limited are the cases of pediatric EGPA patients presenting with isolated stridor and severe subglottic stenosis, with only one reported case published to our knowledge to date. 2 We present the case of an 18-year-old female who initially developed expiratory stridor two years ago, with no other significant medical history. CT imaging revealed non-fixed pulmonary infiltrates, and endoscopic evaluation revealed grade 3 subglottic stenosis. Biopsy results of the stenotic segment showed reactive epithelium with eosinophils present. Lower airway bronchoscopy with bronchoalveolar lavage demonstrated eosinophils, neutrophils, and macrophages, and serology tests resulted positive for ANCA antibodies. These findings, together with the patient’s symptoms, are most consistent with EGPA disease. Initially deemed as severe asthma exacerbation, this case highlights the importance of considering autoimmune conditions in patients with expiratory stridor and/or idiopathic subglottic stenosis.