Eosinophilic granulomatosis with polyangiitis (formerly Churg–Strauss syndrome)

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Eosinophilic granulomatosis with polyangiitis (formerly Churg–Strauss syndrome) is a systemic vasculitis.

It can present with psychiatric features such as depression, anxiety, behavioural change, cognitive dysfunction, mood disturbance, and, less commonly, psychosis.

Other characteristic features include peripheral neuropathy (particularly mononeuritis multiplex), headache, seizures, cerebrovascular events, and, less commonly, encephalopathy. Distinctive features include eosinophil-rich small- to medium-vessel vasculitis, often occurring in the context of adult-onset asthma, allergic disease, and peripheral eosinophilia. Anti-myeloperoxidase (MPO)-ANCA positivity is present in a subset of patients.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Respiratory: adult-onset asthma, chronic rhinosinusitis, nasal polyps, pulmonary infiltrates, and respiratory symptoms related to eosinophilic airway and lung involvement.

  • Cardiovascular: myocarditis, cardiomyopathy, pericarditis, and other cardiac involvement may occur and represent important causes of morbidity.

  • Renal/electrolytes: glomerulonephritis may occur, particularly in ANCA-positive disease, although renal involvement is generally less frequent than in granulomatosis with polyangiitis and microscopic polyangiitis.

  • Gastrointestinal: abdominal pain, eosinophilic gastrointestinal involvement, and mesenteric vasculitis may occur.

  • Musculoskeletal: arthralgia, myalgia, and inflammatory arthritis may occur.

  • Dermatologic: palpable purpura, nodules, urticaria, and other cutaneous vasculitic manifestations may occur.

Early diagnosis is important to enable prompt immunosuppressive therapy, prevent irreversible neurological and cardiovascular complications, reduce the risk of organ-threatening vasculitic injury, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.