Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6105-6109
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6105
Successful treatment of acute relapse of chronic eosinophilic pneumonia with benralizumab and without corticosteroids: A case report
Shimon Izhakian, Barak Pertzov, Dror Rosengarten, Mordechai R Kramer
Shimon Izhakian, Barak Pertzov, Dror Rosengarten, Mordechai R Kramer, Pulmonary Institute, Rabin Medical Center, Petach Tikva 49100, Israel
Shimon Izhakian, Barak Pertzov, Dror Rosengarten, Mordechai R Kramer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
Author contributions: Izhakian S and Rosengarten D contributed to the acquisition and interpretation of the data; Pertzov B and Kramer MR contributed to the critical revision of the manuscript for important intellectual content; all authors contributed to the drafting of the manuscript and approved the final version.
Informed consent statement: Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shimon Izhakian, MD, PhD, Doctor, Pulmonary Institute, Rabin Medical Center, No. 39 Jabotinski St., Petach Tikva 49100, Israel. shimixyz@gmail.com
Received: April 14, 2021
Peer-review started: April 14, 2021
First decision: September 28, 2021
Revised: November 5, 2021
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: June 26, 2022
Processing time: 428 Days and 12.4 Hours
Abstract
BACKGROUND

Currently, the mainstay of chronic eosinophilic pneumonia (CEP) treatment is corticosteroids, usually with a favorable response and good prognosis. However, relapse is common, requiring long-term use of corticosteroids, with risk of significant treatment-related complications. The dire need to develop new treatments for patients with CEP, who are dependent on, or resistant to corticosteroids has led to exploring novel therapies. We herein describe a patient with acute relapse of CEP, who was successfully treated with benralizumab, an IL-5Rα antagonist that has demonstrated rapid anti-eosinophil action in patients with asthma. Currently, only three recent patient reports on CEP relapse, also demonstrated successful treatment with benralizumab alone, without corticosteroids.

CASE SUMMARY

A 31-year-old non-smoking woman presented in our hospital with a 3 wk history of shortness of breath, dry cough and fever up to 38.3 °C. Laboratory examination revealed leukocytosis 10240 K/µL, eosinophilia 900 K/µL and normal values of hemoglobin, platelets, creatinine and liver enzymes. Computed tomography of the chest showed a mediastinal lymphadenopathy and consolidations in the right upper and left lower lobes. CEP was diagnosed, and the patient was treated with hydrocortisone intravenously, followed by oral prednisone, with prompt improvement. Three months later, she presented with relapse of CEP: aggravation of dyspnea, rising of eosinophilia and extension of pulmonary infiltrates on chest X-ray. She was treated with benralizumab only, with clinical improvement within 2 wk, and complete resolution of lung infiltrates following 5 wk.

CONCLUSION

Due to Benralizumab’s dual mechanism of action, it both neutralizes IL-5Rα pro-eosinophil functions and triggers apoptosis of eosinophils. We therefore maintain benralizumab can serve as a reasonable therapy choice for every patient with chronic eosinophilic pneumonia and a good alternative for corticosteroids.

Keywords: Benralizumab; Eosinophilic pneumonia; Interstitial lung disease; Corticosteroid withdrawal; Case report

Core Tip: Chronic eosinophilic pneumonia (CEP) is an idiopathic pulmonary disease, characterized by marked eosinophil accumulation in the pulmonary parenchyma. Currently, the mainstay of CEP treatment is corticosteroids. However, relapse is common, requiring long-term use of corticosteroids, with the risk of significant treatment-related adverse effects. Herein, we describe a patient with an acute CEP relapse, successfully treated with benralizumab alone, without corticosteroids. Currently, only three patients with acute relapse of CEP, were reported successfully treated with benralizumab alone, without corticosteroids. This therapy option may be particularly beneficial for patients who have previously suffered serious adverse effects from or have any contraindications to chronic corticosteroid treatment.