In Churg‑Strauss syndrome (eosinophilic granulomatosis with polyangiitis), which of the following findings are observed: mononeuritis multiplex, migratory arthritis, pulmonary‑renal syndrome, peripheral eosinophilia, or recurrent aphthous stomatitis?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 8, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Churg-Strauss Syndrome (EGPA): Clinical Findings

In Churg-Strauss syndrome (EGPA), both mononeuritis multiplex (a) and peripheral eosinophilia (d) are characteristic findings, while migratory arthritis, pulmonary-renal syndrome, and recurrent aphthous stomatitis are not typical features of this disease.

Core Clinical Features

According to the most recent evidence-based guidelines, EGPA is characterized by a specific constellation of findings 1:

Hallmark Features (Present in EGPA):

a) Mononeuritis multiplex - This is a classic vasculitic manifestation occurring during the vasculitic phase of EGPA. The guidelines explicitly state that the vasculitic phase is "characterized by clinical manifestations due to small-vessel vasculitis (for example, mononeuritis multiplex and glomerulonephritis)" 1. Peripheral neuropathy, particularly mononeuritis multiplex, occurs more frequently in ANCA-positive patients and is documented in 55-75% of cases 2, 3, 4.

d) Peripheral eosinophilia - This is a defining feature of EGPA. The disease is fundamentally "characterized by asthma, eosinophilia and granulomatous or vasculitic involvement of several organs" 1. The eosinophilic phase specifically involves "eosinophilia and end-organ involvement" 1. Marked peripheral blood eosinophilia (>10%) is consistently present and is central to the pathophysiology 2, 4.

Features NOT Typical of EGPA:

b) Migratory arthritis - While arthritis/arthralgias can occur in EGPA, migratory arthritis is not a characteristic feature. The guidelines do not list this as a typical manifestation 1.

c) Pulmonary-renal syndrome - Although EGPA can affect both lungs and kidneys, the classic "pulmonary-renal syndrome" (alveolar hemorrhage with rapidly progressive glomerulonephritis) is more characteristic of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). In EGPA, glomerulonephritis occurs more commonly in ANCA-positive patients but is not the dominant presentation 1. Pulmonary involvement in EGPA typically manifests as asthma (>90% of cases) and migratory infiltrates rather than hemorrhage 1, 3.

e) Recurrent aphthous stomatitis - This is not a recognized feature of EGPA. The guidelines emphasize ear-nose-throat disease (60-80% of patients) in the form of chronic rhinosinusitis with nasal polyps, not oral ulceration 1.

Clinical Context

EGPA typically evolves through three overlapping phases 1:

  • Allergic phase: Asthma and chronic rhinosinusitis (can last years)
  • Eosinophilic phase: Peripheral eosinophilia with organ infiltration
  • Vasculitic phase: Small-vessel vasculitis causing mononeuritis multiplex, glomerulonephritis, purpura

Critical distinction: ANCA-positive patients (40% of cases) show more vasculitic features (glomerulonephritis, peripheral neuropathy, purpura), while ANCA-negative patients demonstrate more eosinophilic features (cardiac involvement, gastroenteritis) 1.

References

Related Questions

What is the recommended treatment regimen for Churg‑Strauss syndrome (eosinophilic granulomatosis with polyangiitis)?
A 30-year-old female with bilateral posterior foot white crusting and oozing blood—what is the diagnosis and appropriate treatment with dosages?
Are constitutional symptoms more common in Wegener's granulomatosis (granulomatosis with polyangiitis) or Churg‑Strauss syndrome (eosinophilic granulomatosis with polyangiitis)?
Do patients with eosinophilic granulomatosis with polyangiitis require trimethoprim‑sulfamethoxazole (cotrimoxazole) prophylaxis, and what does current evidence indicate?
What findings can be observed on electrocardiogram (ECG) and echocardiogram in patients with Churg‑Strauss syndrome (eosinophilic granulomatosis with polyangiitis)?
In a 22-year-old woman with acute, movement‑dependent right‑upper‑quadrant pain radiating to the umbilicus and a history of three egg‑retrieval procedures three years ago, what urgent evaluation and diagnostic work‑up is recommended?
Can a patient have both crackles and wheezing simultaneously?
In a young woman with a history of egg‑retrieval procedures who now presents with right lower quadrant abdominal pain, what urgent work‑up and possible life‑threatening diagnoses should be considered?
In a young woman with a history of egg retrieval three years ago who now presents with right lower‑quadrant abdominal pain, what are the appropriate diagnostic steps and likely differential diagnoses?
What is the likely diagnosis for a 30-year-old woman with recurrent weekly episodes of muscle aches, insomnia, fatigue, and restless‑leg sensations occurring every 1–2 months over the past 2 years, without joint pain, swelling, headaches, fever, menstrual or stress triggers?
In an 84-year-old woman with borderline hypercalcemia, markedly elevated intact parathyroid hormone (PTH), and mildly impaired renal function (creatinine 1.24 mg/dL), what is the most likely diagnosis and how should it be evaluated and managed?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.