Benralizumab in Corticosteroid-Refractory Drug Reaction With Eosinophilia and Systemic Symptoms: A Case Report

TL;DR

A 20-year-old man with severe DRESS unresponsive to steroids improved rapidly after a single dose of benralizumab, suggesting it as a promising treatment.

Contribution

Demonstrates benralizumab's efficacy in corticosteroid-refractory DRESS, supporting IL-5 axis blockade as a novel therapeutic strategy.

Findings

The patient showed rapid clinical and laboratory improvement after a single benralizumab dose.

Benralizumab may be effective in severe DRESS cases unresponsive to corticosteroids.

IL-5 receptor blockade could be a promising treatment strategy for corticosteroid-refractory DRESS.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction involving multiple organ systems. While high-dose systemic corticosteroids are the first-line treatment, some cases are refractory, and effective second-line options are limited. We report a case of a 20-year-old male with lamotrigine-induced DRESS, presenting with rash, fever, eosinophilia, and fulminant hepatic failure unresponsive to corticosteroids. Following a single subcutaneous dose of benralizumab, an interleukin-5 (IL-5) receptor monoclonal antibody, the patient exhibited rapid clinical and laboratory improvement, narrowly avoiding liver transplantation. Benralizumab has demonstrated efficacy in corticosteroid-refractory DRESS cases, often achieving resolution with a single dose. This case supports the potential role of IL-5 axis blockade as a promising therapeutic strategy in managing severe DRESS.

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