Case Report: Benralizumab combined with a steroid-sparing strategy in a case of severe eosinophilic granulomatosis with polyangiitis.

Authors

Nanxi Zhou, Chunxiao Fang, Min Feng, Chang Dong

Published in

Frontiers in immunology. Volume 17. Pages 1820718. Epub Jun 17, 2026.

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by eosinophilic inflammation and necrotizing vasculitis. Benralizumab, an anti-IL-5Rα monoclonal antibody that directly targets eosinophils, was approved for EGPA in China in December 2025. We report an early real-world experience of benralizumab combined with corticosteroids in a patient with severe ANCA-negative EGPA.
A 73-year-old male with a history of childhood asthma, chronic rhinosinusitis, CKD stage 4 presented with recurrent pulmonary infiltrates, progressive interstitial lung disease, severe eosinophilia (peak 12.90×10⁹/L), diffuse skin lesion and new-onset arrhythmia. After systematic differential diagnosis, EGPA was diagnosed according to the 2022 ACR/EULAR criteria (score 7). BALF and blood testing detected nucleic acids of Pneumocystis jirovecii and CMV. He was treated with methylprednisolone 40 mg/day and subcutaneous benralizumab 30 mg every 4 weeks. Concurrently, empirical preemptive anti-infective therapy (caspofungin for Pneumocystis jirovecii, ganciclovir for CMV) was initiated. At 4-week follow-up, prednisone was tapered to 30 mg/day; dyspnea and rash markedly improved, eosinophils decreased to 0, IgE fell from 1,860 to 519 IU/mL, chest CT showed significant resolution of infiltrates, and pulmonary function improved from severe to mild restrictive impairment. At 3 months, prednisone was further tapered to 25 mg/day in combination with benralizumab, and the patient remained stable without disease relapse or acute infection.
This case represents an early real-world application of benralizumab in a high-risk ANCA-negative EGPA patient following its approval in China. The findings suggest that benralizumab, used as an adjunctive steroid-sparing agent, may facilitate rapid corticosteroid tapering in selected vulnerable patients with infection risk. Long-term follow-up and studies are needed to validate these findings.

PMID:
42389539
Bibliographic data and abstract were imported from PubMed on 02 Jul 2026.

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