Successful early introduction of mepolizumab for peripheral neuropathy with a peripheral circulatory disorder in a patient with myeloperoxidase anti-neutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis

Abstract

A 26-year-old woman presented with abdominal pain, diarrhoea, vomiting, fever, and progressive paralysis in the lower limbs. She had a history of bronchial asthma and experienced sinusitis, progressive peripheral neuropathy, polyarthritis, and leukocytosis with prominent eosinophilia. The patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Abdominal pain was considered to be an ischaemic enteritis associated with EGPA. She was administered 1,000 mg/day of methylprednisolone for 3 days and intravenous immunoglobulin (400 mg/kg/day of γ-globulin for 5 days) followed by 50 mg (1 mg/kg)/day of oral prednisolone due to rapidly progressing peripheral neuropathy. Her symptoms temporarily improved; however, peripheral neuropathy recurred after a week, and the eosinophil count increased. Eighteen days after following the resumed treatment, 300 mg of mepolizumab, a humanised monoclonal antibody, was administered. Subjective symptoms, nerve conduction velocity, and skin perfusion pressure (an index of peripheral circulation in the lower extremities) improved after 4 weeks. Although mepolizumab has been approved for EGPA, there is no evidence of its efficacy against peripheral neuropathy. Early introduction of mepolizumab may contribute to an the early improved progressive peripheral neuropathy with eosinophilia.

Keywords:

• Eosinophilic granulomatosis with polyangiitis
• peripheral neuropathy
• mepolizumab
• skin perfusion pressure

Acknowledgement

We would like to thank Editage (www.editage.com) for English language editing.

Patient consent

Written informed consent for the publication of this report was obtained from the patient.

Ethical approval

Not applicable.

Conflict of interest

N Kitamura received lecture fee from AbbVie GK., Actelion Pharmaceuticals Japan Ltd., Asahi Kasei Corporation, Astellas Pharma Inc., Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eli Lilly Japan K.K., Esai Co., Ltd., GlaxoSmithKline K.K., Janssen Pharmaceutical K.K., Mitsubisi Tanabe Pharma Corporation, Pfizer Inc., Sanofi K.K., Takeda Pharmaceutical Co., Ltd. and Teijin Pharma Ltd. M Takei received lecture fee from Astellas Pharma Inc., Celgene Co., Chugai Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Pfizer Inc., Janssen Pharmaceutical K.K. and Takeda Pharmaceutical Co., Ltd. H Kobayashi received lecture fee from Kissei Pharmaceutical Co., Ltd.

Additional information

Funding

There is no direct funding for this study, but we receive a scholarship donation from Asahi Kasei Corporation, Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., GlaxoSmithKline plc., Pfizer Inc., Teijin Pharma Ltd., Takeda Pharmaceutical Co., Ltd., to our group.