Benralizumab for eosinophilic granulomatosis with polyangiitis and subclinical cardiac involvement: a fertility-preserving case report

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ID: 327116
2026
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Abstract
Cardiac involvement, which may remain clinically silent, is a major determinant of prognosis in eosinophilic granulomatosis with polyangiitis (EGPA), and remission induction generally requires glucocorticoids combined with cyclophosphamide or rituximab. In contrast, treatment selection may be challenging in women wishing to preserve fertility because cyclophosphamide carries a risk of gonadal toxicity. We report a 40-year-old woman with a history of asthma, eosinophilic chronic rhinosinusitis, and eosinophilic otitis media who developed postpartum-onset EGPA and presented with neurological and cutaneous manifestations. Elevated cardiac troponin I levels and newly developed electrocardiographic abnormalities suggested subclinical myocardial injury despite the absence of cardiac symptoms. Intravenous methylprednisolone pulse therapy was initiated immediately. Because cardiac troponin I levels showed no early decline after glucocorticoid initiation, and glucocorticoid monotherapy was considered potentially insufficient to control eosinophil-mediated myocardial injury, additional eosinophil-targeted therapy was selected after shared decision-making that balanced fertility preservation with the need for prompt disease control. Benralizumab was chosen because of its potent eosinophil-depleting effect. Peripheral eosinophils rapidly decreased to zero, troponin I normalized by Day 26, and glucocorticoids were successfully discontinued within 5 months. To our knowledge, this is the first report of benralizumab used as part of a fertility-preserving remission-induction strategy to avoid cyclophosphamide in a woman with EGPA and cardiac involvement. This approach may represent an individualized therapeutic option for carefully selected patients in whom fertility preservation is an important treatment consideration.
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Authors Takashi Yamane, Ayaka Inoue, Mari Nishio
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Journal Modern Rheumatology Case Reports
Year 2026
DOI
10.1093/mrcr/rxag086
URL
https://doi.org/10.1093/mrcr/rxag086
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