BREATHING FOR TWO: A CASE OF SEVERE EOSINOPHILIC ASTHMA DURING PREGNANCY TREATED WITH BENRALIZUMAB

Abstract

Introduction The following is a case of severe eosinophilic asthma during pregnancy treated with benralizumab. Case Description A 31-year old female diagnosed with asthma presented to the hospital with tachycardia, severe dyspnea and wheezing. A CBC revealed eosinophilia of 6,940 cells/mL and a multifocal pneumonia on HRCT. 2D echo showed a pericardial effusion with impending tamponade. Eosinophilia was noted in pericardial fluid (162 cells/mL), in bronchoscopy BAL fluid (208 cells/mL) and on pericardial biopsy. Bone marrow biopsy was normal. Strongyloides IgG was positive, but two courses of ivermectin did not change her clinical course. High dose glucocorticoids improved her symptoms and eosinophilia. Outpatient initiation of benralizumab allowed for further symptom control and tapering of glucocorticoids. Benralizumab was stopped due to pregnancy with recurrence of eosinophilia and asthma symptoms twelve weeks after discontinuation, requiring high dose daily glucocorticoids. Given concerns for new onset peripheral edema and poorly controlled asthma with progressive eosinophilia, benralizumab was restarted at 20 weeks gestation. Within two weeks, her peripheral edema, eosinophilia and her asthma symptoms improved. She is now on low dose corticosteroids. Discussion Glucocorticoid use during pregnancy is associated with gestational diabetes, cleft palate and still births. However, it is often first line therapy for acute asthma exacerbations and poorly controlled asthma during pregnancy. Human data on benralizumab in pregnancy is extremely limited, consisting of immediate cessation of therapy in two patients found to be pregnant in the BISE trial. This case demonstrates the use of benralizumab during the majority of gestation with limited fetal complications.