[TWO CASES OF MPO-ANCA-POSITIVE EGPA WITH CHRONIC RHINOSINUSITIS SHOWING DIFFERENT RESPONSES TO MEPOLIZUMAB]

Area of Science:

• Immunology
• Rheumatology
• Otolaryngology

Background:

• Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis often linked to chronic rhinosinusitis (CRS) and asthma.
• Mepolizumab, an anti-interleukin-5 monoclonal antibody, is utilized in EGPA treatment.
• ANCA-associated vasculitis, including EGPA, presents complex management challenges.

Purpose of the Study:

• To investigate the variable response to mepolizumab in MPO-ANCA-positive EGPA patients with CRS.
• To highlight the clinical course and treatment outcomes in two distinct EGPA cases.
• To emphasize the need for personalized treatment strategies and ongoing monitoring in EGPA.

Main Methods:

• Case report analysis of two patients with MPO-ANCA-positive EGPA and CRS.
• Evaluation of treatment responses to mepolizumab, including nasal symptom resolution and surgical outcomes.
• Comparison of clinical trajectories following mepolizumab and, in one case, dupilumab administration.

Main Results:

• Case 1 demonstrated persistent nasal symptoms and early recurrence of CRS despite mepolizumab and endoscopic sinus surgery (ESS).
• Case 2 experienced symptom improvement with mepolizumab after EGPA developed post-dupilumab, maintaining good control.
• These contrasting outcomes indicate patient-specific efficacy of mepolizumab for CRS in ANCA-positive EGPA.

Conclusions:

• The effectiveness of mepolizumab in managing CRS within ANCA-positive EGPA is variable.
• Recurrence of CRS is possible even with effective initial treatment, necessitating vigilant follow-up.
• Close collaboration between specialists is crucial for optimal long-term management of EGPA patients.