Eosinophilic small vessel vasculites (EGPA) a hidden severe asthma comorbitity

Ólafur Orri Sturluson¹

Ólafur Pálsson²

Einar Hjaltested³

Dóra Lúðvíksdóttir⁴

¹Department of Internal medicine, Landspitali University Hospital, ²Department of Rheumatology, Landspitali University Hospital, ³Department of Otolaryngology, Landspitali University Hospital, ⁴Department of Pulmonology, Landspitali University Hospital

Correspondence: Ólafur Orri Sturluson, olafuros@landspitali.is

Key words: EGPA, asthma, mepolizumab, eosinophilic granulomatosis with polyangiitis.

A 72-year-old woman presented to the emergency department due to worsening dyspnea. She had been diagnosed with asthma a year earlier. At arrival, her oxygen saturation was only 84%. During lung auscultation, wheezing was noted over all lung fields. A blood test showed a significant increase in eosinophils in peripheral blood, highest value of 1.4 x 10E9/L.

Further investigations in the respiratory ward showed a positive MPO-ANCA, which, together with clinical features of asthma, chronic rhinosinusitis with polyps, mononeuritis multiplex and eosinophilia, led to the diagnosis of eosinophilic granulomatosis with polyangiitis, or what used to be called Churg-Strauss syndrome. Corticosteroid treatment was initiated and subsequently tapered down when treatment with mepolizumab was started, which is an IL-5 inhibitor. Her symptoms quickly became much better. Frequent exacerbations and pulmonary symptoms became things of the past.