ReviewClinical rheumatology2026
Glucocorticoid-free remission with simultaneous mepolizumab and rituximab in life-threatening PR3-ANCA-positive eosinophilic granulomatosis with polyangiitis: a case report and literature review.
Review in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Patients with features of multiple systemic vasculitides are rare but do exist and can be diagnostically challenging. In particular, it can be difficult to distinguish granulomatosis with polyangiitis (GPA) with eosinophilia, proteinase 3 (PR3)-ANCA-positive eosinophilic granulomatosis with polyangiitis (EGPA), and overlap of GPA and EGPA in clinical practice. Nevertheless, in severe cases, rapid therapeutic decisions are required. We report such a life-threatening case of PR3-ANCA-positive vasculitis with eosinophilia, refractory to conventional therapy, that achieved remission with simultaneous biologic therapy using mepolizumab (MPZ) and rituximab (RTX) and provide a case-based review of the efficacy and safety of this dual biologic therapy. An 18-year-old man presented with cough, hemoptysis, leg purpura, and marked eosinophilia (4575/μL). Chest CT revealed alveolar hemorrhage (DAH). Proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibody (ANCA) was positive, and skin biopsy showed leukocytoclastic vasculitis with eosinophil infiltration, consistent with EGPA. He was refractory to methylprednisolone (mPSL) pulse therapy and intravenous cyclophosphamide (IVCY), and DAH worsened, requiring non-invasive ventilation. Plasma exchange, MPZ (300 mg), and RTX (375 mg/m
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