Abstract Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, multisystem small- to medium-vessel vasculitis that lies within the spectrum of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. It is distinguished by a triad of asthma, peripheral and tissue eosinophilia, and necrotizing granulomatous inflammation. Management relies on systemic glucocorticoids as first-line therapy, while immunosuppressive agents such as Cyclophosphamide, Azathioprine, or Methotrexate are indicated for severe or refractory disease. Recent advances have highlighted the efficacy of biologic therapies targeting eosinophilic pathways, including anti-IL-5 agents such as Mepolizumab, offering steroid-sparing potential and improved disease control. Here, we describe a case of a gentleman with severe EGPA involving multiple systems that initially improved with Rituximab but required the addition of Mepolizumab to control persistent sinusitis despite Rituximab monotherapy. There is currently limited evidence to support the use of dual therapy with Rituximab and Mepolizumab for the treatment of EGPA due to concern for excessive immunosuppression. This case shows that Rituximab and Mepolizumab combination therapy can achieve better control of disease than Rituximab monotherapy without causing more infections. This abstract is funded by: N/A
Awsare et al. (Fri,) studied this question.