This case report describes the clinical course and management of a 59-year-old patient known for HBV chronic infection presented in July 2019 with a late-onset asthma associated with peripheral eosinophilia and nasal polyposis. Respiratory function revealed severe airflow obstruction (FEV/FVC 36%, FEV1 0.97 litre) despite prolonged inhaled corticosteroid therapy. The CT scan showed extensive bronchiolitis features. Antineutrophilic cytoplasmic antibodies (ANCA) assessed by indirect immunofluorescence, and anti-myeloperoxidase (MPO) and anti-proteinase 3 antibodies measured using antigen-specific fluorimetry assay were all negative. Bronchoalveolar lavage showed 43% eosinophils. There was no extra-respiratory involvement. The patient was diagnosed with hypereosinophilic bronchiolitis. He received 1 mg/kg/day of oral prednisone, slowly tapered down to 10 mg/day over 6 months, with a dramatic clinical improvement, and normalisation of lung function, chest CT, and blood count. On day 34 of COVID-19 related first symptoms, while still receiving 20 mg/ day of prednisone, he was admitted to intensive care unit with acute respiratory distress associated with low grade fever, wheezes at auscultation, and groundglass opacities, ill-defined lung consolidation and pansinusitis at CT. Skin examination showed a necrotic purpura on both legs. Eosinophilic count was 6.8 x109 /litre. Repeated nasopharyngeal RT-PCR for SARS-Cov-2 was negative.
Evolution from hypereosinophilic bronchiolitis to eosinophilic granulomatosis with polyangiitis following COVID-19: a case report. (Special Issue: Letter to editor rheumatology: commentaries and controversies.)