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Case Reports
. 2021 Nov 29;10(1):e0878.
doi: 10.1002/rcr2.878. eCollection 2022 Jan.

Switching from omalizumab to mepolizumab therapy improved extra-pulmonary abdominal and cutaneous vasculitis symptoms in a patient with eosinophilic granulomatosis with polyangiitis

Yu-Hsuan Chen  1 , Ping-Hung Kuo  1
Affiliations
Case Reports

Switching from omalizumab to mepolizumab therapy improved extra-pulmonary abdominal and cutaneous vasculitis symptoms in a patient with eosinophilic granulomatosis with polyangiitis

Yu-Hsuan Chen et al. Respirol Case Rep. .

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis of small-to-medium-sized vessels. Both eosinophilic infiltration and vasculitis are thought to contribute to multi-organ damage. Some biologics have been used to reduce the required dose of corticosteroids in EGPA, but no single agent can ensure a complete control of this disease. Here, we describe a patient with anti-neutrophil cytoplasmic antibodies-negative relapsing EGPA whose asthma control was improved by omalizumab, but she continued to develop flares of abdominal and cutaneous vasculitis symptoms. After switching to mepolizumab therapy, her blood hypereosinophilia and extra-pulmonary symptoms were significantly improved. Moreover, the dose of daily maintenance corticosteroid could be tapered off. The experience from our case suggests that biologics targeting interleukin-5 may be more effective than omalizumab in the management of extra-thoracic manifestations in EGPA.

Keywords: eosinophilic granulomatosis with polyangiitis; extra‐pulmonary; mepolizumab; omalizumab; switching.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Axial and coronal views of the chest computed tomography during flare‐up (A1–A3) and remission (B1–B3) of eosinophilic granulomatosis with polyangiitis
FIGURE 2
FIGURE 2
Time course of blood eosinophil counts, treatments and clinical parameters. *Month 0: Initial visit to our hospital. ACT, Asthma Control Test; BVAS, Birmingham Vasculitis Activity Score; PEFR, peak expiratory flow rate
See this image and copyright information in PMC

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