Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis that may present with asthma, eosinophilia, pulmonary involvement, and peripheral neuropathy. Distinguishing EGPA-related vasculitic neuropathy from diabetic neuropathy can be particularly challenging in patients with long-standing diabetes mellitus. We present a case of a 64-year-old man with type 2 diabetes, chronic kidney disease, and asthma, who developed systemic symptoms, mononeuritis multiplex, and pulmonary haemorrhage. Laboratory tests revealed marked eosinophilia and strongly positive myeloperoxidase (MPO)-ANCA, while electrophysiological studies demonstrated asymmetric axonal neuropathy. A multidisciplinary assessment by neurology and rheumatology confirmed the diagnosis of EGPA with vasculitic neuropathy, following which treatment with corticosteroids, cyclophosphamide, plasmapheresis, and rituximab resulted in significant clinical improvement. This case highlights the importance of recognizing atypical or asymmetric neuropathies in diabetic patients and considering EGPA early to prevent irreversible organ damage

Muhammad Zeeshan Khan graduated from Khyber Medical University, Pakistan, with a Bachelor of Medicine degree in 2013. He registered with the General Medical Council and commenced his medical career in the UK in 2018. In April 2024, he attained Membership of the Royal College of Physicians of Edinburgh. He is currently undertaking specialist training in Acute Medicine within the Mersey and West Lancashire Deanery.