Benralizumab for anti‐tumor necrosis factor‐associated eosinophilic gastrointestinal disease in a child with ileal Crohn's: A case report

Abstract Crohn's disease (CD) and eosinophilic gastrointestinal diseases (EGIDs) are distinct inflammatory entities, but eosinophilic disease may emerge as a paradoxical immune complication of anti–tumor necrosis factor therapy. We report a 12‐year‐old boy with terminal ileal CD who developed severe eosinophilic gastritis and ileitis, peripheral eosinophilia, and psoriasiform dermatitis during prolonged anti‐TNF treatment, despite CD remission. Corticosteroids, dietary modification, and sequential biologic therapy resulted in incomplete or transient responses. Following anti‐TNF withdrawal, eosinophilic disease persisted, prompting compassionate off‐label treatment with benralizumab, an interleukin‐5 (IL‐5) receptor α‐antagonist, alongside vedolizumab for CD maintenance. Benralizumab led to rapid normalization of peripheral eosinophil counts, resolution of gastrointestinal symptoms, improved food tolerance, and histologic remission at 6 months. This case illustrates persistent anti‐TNF–associated immune deviation and supports targeted IL‐5 receptor blockade as an effective strategy for refractory eosinophilic gastrointestinal disease while maintaining CD remission.