DISCUSSION: This case well illustrates EGPA. Patients classically experience a prodromal phase, which can last months to one year, and is characterized by a diagnosis of asthma. This is followed by the eosinophilic phase, as eosinophils begin to infiltrate various tissues. During the eosinophilic phase, patients may experience symptoms akin to sinusitis. Other organs can be affected, including myocardium and the gastrointestinal tract. Lastly, the patient progresses to the vasculitic phase, which is characterized by widespread manifestations of systemic vasculitis such as skin lesions (as in our patient) and neuropathies.1 EGPA is currently diagnosed based on criteria proposed by the American College of Rheumatology; those criteria include 1) asthma, 2) eosinophilia > 10%, 3) neuropathy, 4) pulmonary infiltrates, 5) sinusitis, and 5) eosinophilic infiltration on biopsy. The presence of 4/6 of these criteria carry a sensitivity of 85% and a specificity of 99.7% in diagnosing EGPA.2 Treatment of this condition is based on the presence of end organ damage. Patients without significant end organ damage- myocardial, kidney, central nervous system or gastrointestinal involvement- may be treated with steroids alone. Patients that do have evidence of more widespread disease also require cyclophosphamide therapy.3 Some patients with EGPA may achieve remission following steroids alone, but many relapse and treatment of these patients is controversial.