{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:29:23Z","timestamp":1786598963425,"version":"build-2736575974"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":83,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, systemic vasculitis characterised by asthma, eosinophilia, and multi-organ involvement. Diffuse alveolar haemorrhage (DAH) is an uncommon, but life-threatening pulmonary complication in EGPA. We report on a 49-year-old, previously healthy woman who presented initially with asthma-like symptoms and later developed a fever, haemoptysis, cutaneous purpura, and periorbital oedema. Laboratory evaluation revealed marked eosinophilia, anaemia, elevated inflammatory markers, and a strongly positive MPO-ANCA. Bronchoalveolar lavage fluid was haemorrhagic and contained hemosiderin-laden macrophages, indicating DAH. Broad-spectrum antibiotics were empirically initiated but discontinued after metagenomic next-generation sequencing (mNGS) of the bronchoalveolar lavage fluid excluded infection. A bone marrow biopsy showed eosinophilic hyperplasia without clonal mutations. A diagnosis of MPO-ANCA positive EGPA with DAH was established. The patient received pulse methylprednisolone, prednisone, intravenous immunoglobulin, mepolizumab, and rituximab. Clinical symptoms improved rapidly, and radiological signs of alveolar haemorrhage had nearly resolved within days. Our case illustrates that the integration of rituximab and mepolizumab with corticosteroids can achieve rapid remission and steroid sparing in EGPA-DAH. While evidence remains limited to case reports and small series, targeted biologics may fundamentally improve outcomes in this high-risk subset. Prospective studies are warranted to define optimal treatment strategies.<\/jats:p>","DOI":"10.1093\/mrcr\/rxag028","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:46:37Z","timestamp":1774442797000},"source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic evolution and outcomes in EGPA complicated by diffuse alveolar haemorrhage: Case-based review"],"prefix":"10.1093","volume":"10","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital , Taiyuan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital , Taiyuan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"2026081301163268100_ref1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1136\/annrheumdis-2021-221794","article-title":"2022 American College of Rheumatology\/European Alliance of associations for rheumatology classification criteria for eosinophilic granulomatosis with polyangiitis","volume":"81","author":"Grayson","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2026081301163268100_ref2","doi-asserted-by":"crossref","first-page":"103219","DOI":"10.1016\/j.autrev.2022.103219","article-title":"Eosinophilic granulomatosis with polyangiitis: a review","volume":"22","author":"White","year":"2023","journal-title":"Autoimmun Rev"},{"key":"2026081301163268100_ref3","first-page":"936","article-title":"Spectrum of ANCA-specificities in eosinophilic granulomatosis with polyangiitis. A retrospective multicentre study","volume":"41","author":"Arnold","year":"2023","journal-title":"Clin Exp Rheumatol"},{"key":"2026081301163268100_ref4","doi-asserted-by":"crossref","first-page":"885198","DOI":"10.3389\/fimmu.2022.885198","article-title":"Clinical significance of MPO-ANCA in eosinophilic granulomatosis with polyangiitis: experience from a longitudinal Chinese cohort","volume":"13","author":"Liu","year":"2022","journal-title":"Front Immunol"},{"key":"2026081301163268100_ref5","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/acr.22686","article-title":"Long-term followup of a multicenter cohort of 101 patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss)","volume":"68","author":"Durel","year":"2016","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026081301163268100_ref6","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1002\/art.37721","article-title":"Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): 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