Transl Clin Pharmacol.  2018 Jun;26(2):60-63. 10.12793/tcp.2018.26.2.60.

Successful additional clarithromycin and tacrolimus treatment for hypereosinophilia associated with eosinophilic granulomatosis with polyangiitis

Affiliations
  • 1Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan. masshi@isis.ocn.ne.jp

Abstract

A 41-year-old man suffering from eosinophilic granulomatosis with polyangiitis (EPGA), diagnosed at another clinic on the basis of American College of Rheumatology Criteria, with a history of bronchial asthma, eosinophilia, mononeuritis multiplex, and non-fixed pulmonary infiltrates, was admitted to our department for further treatment. The patient complained of chest pain that started recently. An echocardiogram identified myocardial thickening and decreased wall motion, based on which the patient was diagnosed as having EPGA with myocarditis. The patient was successfully treated using glucocorticoids, such as methyl prednisolone (PSL) and PSL in combination with cyclophosphamide (CPM). However, CPM administration was discontinued afterwards because of the risk of bone marrow toxicity, the increased eosinophilic count (EOC) that we considered as an index of disease activity. Subsequently, the patient received additional clarithromycin (CAM) and tacrolimus (TAC) treatment considering their immunomodulatory effects. As a result, the EOC decreased and the PSL dosage could be reduced. This case shows that additional CAM and TAC treatment may be beneficial in some cases of EPGA.

Keyword

Churg-Strauss; Clarithromycin; Cyclophosphamide; Prednisolone; Syndrome; Tacrolimus

MeSH Terms

Adult
Asthma
Bone Marrow
Chest Pain
Clarithromycin*
Cyclophosphamide
Eosinophilia
Eosinophils*
Glucocorticoids
Granulomatosis with Polyangiitis*
Humans
Mononeuropathies
Myocarditis
Prednisolone
Rheumatology
Tacrolimus*
Clarithromycin
Cyclophosphamide
Glucocorticoids
Prednisolone
Tacrolimus

Figure

  • Figure 1 (A) A chest roentgenogram shows infiltration shadows in bilateral upper lung fields and right lower lung field. (B) A chest roentgenogram shows improvement in infiltration shadows.


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