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Masking of eosinophilic granulomatosis with polyangiitis: case report In a case series of two patients, a 28-year-old man was described, who experienced masking of eosinophilic granulomatosis with polyangiitis (EGPA) during treatment with unspecified corticosteroids and methylprednisolone, for eosinophilic asthma [not all routes and dosages stated; duration of treatment to reaction onset not stated]. The man, who had a 2 year history of eosinophilic asthma, had been receiving unspecified oral corticosteroids 3 times/year [specific drug not stated]. He also received maintenance therapy with methylprednisolone 8mg daily from July 2019. From October 2019, he received off-label treatment with benralizumab 30mg with a significant improvement in asthma. In December 2019, his treatment with oral corticosteroids was discontinued. In May 2019 (during 36th week of benralizumab treatment), he was admitted with a 2 week history of low-grade fever (up to 37.60C), respiratory insufficiency, productive cough with haemoptysis, arthralgia, arthritis and necrotic skin purpura on the legs. Subsequent laboratory investigations revealed high inflammatory activity including elevated eosinophils 1.31 x 109/L, C reactive protein (CRP) levels of 67 mg/L, erythrocyte sedimentation rate (ESR) of 15 mm/h and the presence of antineutrophil cytoplasmic antibody against myeloperoxidase. Skin biopsy showed pauci-immune necrotizing vasculitis. A lung CT showed mostly peribronchial distributed areas of parenchymal consolidation with ground-glass attenuation, bronchial wall thickening and mucus plugs. Thereafter, based on skin biopsy and computer tomography of lungs, EGPA was diagnosed. Based on the examinations, it was concluded that he had developed EGPA and was in the eosinophilic phase before benralizumab treatment, however, it was masked by daily use of methylprednisolone and frequent use of unspecified oral corticosteroids. His treatment with benralizumab was discontinued. The man started receiving treatment with cyclophosphamide, rituximab and high-dose glucocorticoids with gradual clinical improvement. In December 2019, at follow-up, he was found to have controlled asthma and EGPA. Hocevar A, et al. Eosinophilic granulomatosis with polyangiitis evolution during severe eosinophilic asthma treatment with benralizumab. Journal of Allergy and Clinical 803498303 Immunology: In Practice 8: 2448-2449, No. 7, Aug 2020. Available from: URL: http://doi.org/10.1016/j.jaip.2020.04.006

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Reactions 29 Aug 2020 No. 1819