tacrolimus and Churg-Strauss-Syndrome

While several alternatives to cyclophosphamide have been proposed for refractory eosinophilic granulomatosis with polyangiitis (EGPA), therapeutic options are limited in patients with chronic infections. We report a case of refractory EGPA complicated by invasive aspergillosis and chronic hepatitis B. Although multiple immunosuppressants, including cyclophosphamide, were not effective, tacrolimus was used successfully to control disease without exacerbating concomitant infections in the long term. Tacrolimus could be an alternative choice in the treatment of EGPA, especially when aggressive immunosuppression is unfeasible.

Topics: Antifungal Agents; Antiviral Agents; Churg-Strauss Syndrome; Drug Substitution; Hepatitis B, Chronic; Humans; Immunocompromised Host; Immunosuppressive Agents; Invasive Pulmonary Aspergillosis; Male; Middle Aged; Opportunistic Infections; Tacrolimus; Treatment Outcome

Eosinophilic granulomatosis with polyangitis (EGPA), previously referred to as Churg-Strauss syndrome, is a necrotizing small vessel vasculitis associated with eosinophilic infiltrates and extravascular granulomas. We report a case of a Caucasian woman successfully bridged to heart transplantation with a continuous flow left ventricular assist device (LVAD) who survived recurrence of EGPA in the allograft.

Topics: Churg-Strauss Syndrome; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Prednisone; Recurrence; Tacrolimus

Churg-Strauss syndrome (CSS), which is characterized by systemic small-vessel vasculitis of unknown etiology, is associated with a history of asthma. Although reports of CSS occurring in children are limited, effective treatment of pediatric patients with severe CSS remains challenging. A 10-year-old Japanese boy with a 6-month history of asthma treated with a leukotriene modifier, pranlukast, developed high fever, pleural infiltration, and pericarditis that were associated with marked hypereosinophilia (10,350 eosinophils/µl). Owing to his persistent high fever, mononeuritis multiplex, and severe abdominal pain that was refractory to prednisolone, his general condition progressively deteriorated thereafter. Although intravenous high-dose immunoglobulin administration was transiently effective for mononeuritis multiplex, the recurrent high fever and severe abdominal pain remained refractory. An endoscopic study revealed ulcerative lesions of the total colon. In this context, we treated the patient with an aggressive multidrug immunosuppressive regimen consisting of a high-dose methylprednisolone pulse plus short-course intravenous cyclophosphamide pulse therapy, followed by oral tacrolimus combined with prednisolone. After the rescue multidrug treatment, his severe clinical signs dramatically subsided within a short time, and the concomitantly administered prednisolone was successfully tapered without flare. At present, 12 months after the presentation, he is free from CSS signs or therapy-related toxicity except for an occasional mild asthma attack. Although further close observation should be needed to draw a long-term outcome in this patient, we believe that aggressive multidrug immunosuppressive treatment should be considered as an alternative rescue treatment in selected patients with severe CSS, even with pediatric-onset disease, that is refractory to prednisolone.

Topics: Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Child; Chromones; Churg-Strauss Syndrome; Cyclophosphamide; Drug Resistance; Drug Resistance, Multiple; Eosinophilia; Humans; Immunosuppressive Agents; Japan; Methylprednisolone; Pericarditis; Pleura; Prednisolone; Tacrolimus; Ulcer

Topics: Aged; Asthma; Blood Vessels; Churg-Strauss Syndrome; Comorbidity; Eosinophilia; Female; Humans; Immunosuppressive Agents; Myasthenia Gravis; Osteoporosis; Prednisolone; Skin; Tacrolimus; Treatment Outcome