Supplementary Material for: Gastrointestinal presentation of Eosinophilic Granulomatosis with Polyangiitis, formerly Churg Strauss syndrome – A case report

Some of the most common presentations of gastrointestinal diseases are nausea, vomiting and generalized abdominal pain. These symptoms could also be associated with other diseases and require a structured approach to the specific diagnosis. Eosinophilic granulomatosis with polyangiitis ( EGPA ), also known as Churg Strauss syndrome, is a small and medium-sized vessel vasculitis that can affect any body system and present with a wide range of symptoms and atypical presentation. Therefore, diagnosis of this condition may not always be straightforward. This case report presents a challenging case of a young man presenting with symptoms of abdominal pain, nausea, vomiting and non-specific symptoms of lethargy and fatigue. The case describes overlapping features with granulomatosis with polyangiitis ( GPA ) and antineutrophil cytoplasmic antibodies ( ANCA ) positive and negative vasculitis. The patient needed extensive workup and investigations to be eventually diagnosed with EGPA. In this case, myeloperoxidase ( MPO ) ANCA was negative, which is positive in the majority of EGPA cases, and this poses an additional diagnostic dilemma. The case highlights that non-specific complaints of vomiting and abdominal pain should be addressed methodically and not just be treated symptomatically.