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Clinical Rheumatology

, Volume 36, Issue 9, pp 2159–2162 | Cite as

Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

  • David Aguirre-Valencia
  • Iván Posso-Osorio
  • Juan-Carlos Bravo
  • Fabio Bonilla-Abadía
  • Gabriel J. Tobón
  • Carlos A. Cañas
Case Based Review

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome (CSS), is a small vessel vasculitis associated with eosinophilia and asthma. Clinical manifestations commonly seen in patients presenting with EGPA range from upper airway and lung involvement to neurological, cardiac, cutaneous, and renal manifestations. Treatment for severe presentations includes steroids, cyclophosphamide, plasmapheresis, and recently, rituximab. Rituximab is associated with a good response in the treatment of vasculitis, but a variable response for the control of allergic symptoms. Here, we report a 16-year-old female patient with severe EGPA (gastrointestinal and cutaneous vasculitis, rhinitis and asthma) refractory to conventional treatment. She was treated with rituximab, which enabled rapid control of the vasculitis component of the disease, but there was no response to rhinitis and asthma. Additionally, she developed severe bronchospasm during rituximab infusion. Sequential rituximab and omalizumab were initiated, leading to remission of all manifestations of vasculitis, rhinitis, and asthma, in addition to bronchospasm related to rituximab infusion.

Keywords

Churg-Strauss syndrome EGPA Eosinophilic granulomatosis with polyangiitis Omalizumab Rituximab 

Notes

Compliance with ethical standards

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • David Aguirre-Valencia
    • 1
  • Iván Posso-Osorio
    • 1
  • Juan-Carlos Bravo
    • 2
  • Fabio Bonilla-Abadía
    • 1
  • Gabriel J. Tobón
    • 1
    • 3
  • Carlos A. Cañas
    • 1
  1. 1.GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina TraslacionalFundación Valle del Lili and Univesidad IcesiCaliColombia
  2. 2.Pathology DepartmentFundación Valle del LiliCaliColombia
  3. 3.Immunology LaboratoryFundación Valle del LiliCaliColombia

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