Early Benralizumab Use for the Successful Treatment of Eosinophilic Granulomatosis with Polyangiitis-associated Peripheral Neuropathy.
Marie Sakai, Suzuka Matsuoka, Yuki Takigawa et al.
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Case in brief
A woman in her 40s with bronchial asthma developed limb numbness over three weeks. Examination showed bilateral wheezing and neurological deficits affecting both lower limbs and the right upper limb; blood testing found marked eosinophilia (14,300/μL), supporting a diagnosis of eosinophilic granulomatosis with polyangiitis. Prednisolone and intravenous immunoglobulin improved systemic symptoms, but neuropathy persisted. After benralizumab was started early, neurological function improved markedly, prednisolone was tapered and discontinued, and she remained relapse-free at the time reported.
What made this case unusual
Peripheral neuropathy persisted despite initial treatment with prednisolone and intravenous immunoglobulin, but improved markedly after early benralizumab initiation, permitting corticosteroid withdrawal.
Diagnostic / clinical pearl
In a patient with asthma, limb neuropathy and marked eosinophilia should prompt consideration of eosinophilic granulomatosis with polyangiitis; persistent neuropathy may warrant reassessment of the treatment response.