A 25 year old woman initially presented with a sinonasal mass with watery nasal discharge, frontal headache, and mild facial swelling. Rapid worsening of symptoms prompted surgery via open approach. Biopsy revealed Chronic Granulomatous Inflammation, favoring Tuberculosis. Anti-Koch’s treatment was initiated up to the 5th month but was discontinued due to progression of symptoms. Slide review revealed Eosinophil-rich Granulomatous inflammation. Patient was managed as a case of Eosinophilic Granulomatosis with polyangiitis (EGPA). Rituximab improved the over-all status of the patient. EGPA is a rare vasculitis, presenting with asthma, chronic rhinosinusitis with nasal polyps and peripheral eosinophilia. Diagnosis is often delayed as only 40% of patients are p-ANCA positive. Given the rarity, patients are often misdiagnosed for decades and may present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its associated signs and symptoms. A multi-disciplinary approach is the hallmark in treating this condition, specially in cases of persistence or recurrence.