Rapid effect of benralizumab in fulminant eosinophilic myocarditis in the setting of uncontrolled eosinophilic asthma

A 51-year-old male with uncontrolled asthma and recent convalescence from severe acute respiratory syndrome coronavirus-2c pneumonia presented cough, dyspnea, chest pain. Evaluation revealed significant peripheral eosinophilia, elevated troponin, biventricular failure resulting in cardiogenic shock. He was diagnosed eosinophilic myocarditis subsequently started on high-dose steroids. As he also continued to clinically decline requiring inotropic support, received benralizumab, an anti-eosinophilic monoclonal antibody, as rescue therapy. After benralizumab administration demonstrated improvement his left ventricular ejection fraction, normalization of right function, symptoms resolution hypereosinophilia. Currently, is approved for add-on maintenance treatment patients phenotype asthma. To date, only few observational studies have been published revealing rapid acute, caused by granulomatosis polyangiitis after benralizumab. This clinical case demonstrates that can be used safely conjunction steroid therapy myocarditis. emphasizes the need further research utilizing myocarditis, asthma, other hypereosinophilic syndromes setting.Learning objectiveBenralizumab has However, cases demonstrating drug's use exacerbations. presents a patient fulminant addition The future role drug exacerbation should continue explored.