Eosinophilic granulomatosis with polyangiitis (EGPA) is part of the ANCA-associated vasculitides, although ANCA-negative presentations are not infrequent. Asthma, allergic rhinitis and peripheral eosinophilia are classic associations although pleural effusions are an uncommon manifestation of EGPA. We describe a 35-year old Caucasian adult with asthma who presented with progressive dyspnoea, cough, peripheral eosinophilia and imaging that showed pulmonary nodules with pleural effusions. Biopsy with histopathological review confirmed the diagnosis of EGPA with steroid therapy resulting in significant resolution of symptoms and imaging findings.