Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2022; 10(14): 4502-4508
Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4502
Histological remission of eosinophilic esophagitis under asthma therapy with IL-5 receptor monoclonal antibody: A case report
Marc Huguenot, Anne-Catherine Bruhm, Manfred Essig
Marc Huguenot, Anne-Catherine Bruhm, Manfred Essig, Department of Gastroenterology and Internal Medicine, Tiefenau Hospital, Bern 3004, Switzerland
Author contributions: Huguenot M and Bruhm AC contributed equally to this article; Essig M revised the manuscript.
Informed consent statement: The patient gave informed consent to the publication of this article and general consent is applicable.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marc Huguenot, MD, Chief Physician, Department of Gastroenterology and Internal Medicine, Tiefenau Hospital, Tiefenaustrasse 112, Bern 3004, Switzerland. marc.huguenot@gmail.com
Received: September 27, 2021
Peer-review started: September 27, 2021
First decision: December 4, 2021
Revised: December 17, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 16, 2022
Processing time: 227 Days and 19.2 Hours
Abstract
BACKGROUND

Benralizumab is a monoclonal antibody targeting the IL-5 receptor used in the treatment of asthma. The use of benralizumab in other conditions is only emerging and could represent a therapeutic option for other eosinophil-associated diseases. Here, we report the case of a patient suffering from eosinophilic esophagitis and asthma who achieved histological remission of eosinophilic esophagitis (EoE) under benralizumab treatment for his asthma.

CASE SUMMARY

Our patient was a 56-year-old white male with a history of eosinophilic esophagitis and severe asthma. After years of usual treatments, including topical steroids, biological treatment with mepolizumab, and standard asthma treatment, only poor control of both conditions was obtained. A control gastroscopy after the initiation of benralizumab showed complete histological remission of his EoE.

CONCLUSION

Our case shows the effects of therapy with a novel agent not yet approved for this condition but for other diseases, with histological resolution of EoE after treatment. Complete clinical remission was not observed, which exemplifies the complex nature of EoE, its associated psychosomatic burden, and the chronification of the disease. Nevertheless, monoclonal antibodies targeting the Th2 response and, in our case, an IL5 receptor antagonist, achieved complete histological remission, which was not the case with an antibody against IL-5, which was also initiated to treat asthma.

Keywords: Eosinophilic esophagitis; Benralizumab, Eosinophilic asthma; Case report

Core Tip: Born in 1965, our patient developed the first symptoms of dyspepsia and food impaction at the age of 28. Eosinophilic esophagitis was diagnosed 19 years later in 2012. The first treatment began in 2013 with oral topical glucocorticoids. With concomitant therapy-resistant asthma, treatment with mepolizumab was initiated in addition to standard asthma therapy in 2016. Because of again suboptimal control of asthma, therapy was switched to benralizumab in 2019. In subsequent gastroscopies, histological remission was observed, but our patient reported pain in the esophagus and further food impaction. This case harbors typical aspects of the complexity of treating eosinophilic esophagitis.