Eosinophilic granulomatosis with polyangiitis (EGPA) is an ANCA-associated small-vessels vasculitis characterized by hypereosinophilia and eosinophilic asthma. EGPA with life-threatening organ involvement, particularly cardiac and central nervous system (CNS), is a medical emergency requiring immediate immunosuppression. We describe a 58-year-old patient with a history of chronic rhinosinusitis and eosinophilic asthma, who presented with fever, hypereosinophilia, systemic inflammation and hypotension. Diagnostic workup identified a cardiac mass, CNS vasculitis, CNS embolization and Staphylococcus aureus in blood cultures. Active EGPA with cardiac and CNS involvement complicated by a S. aureus sepsis was diagnosed. In order not affecting antibacterial immunity in active EGPA, antibiotic therapy was combined with Benralizumab, an anti-human IL-5 receptor alpha monoclonal antibody. Benralizumab was well tolerated and EGPA resolved rapidly with its CNS and cardiac manifestations, without compromised antibacterial immunity. Benralizumab could serve as a therapeutic option for eosinophil-mediated pathologies in severely ill patients where immunosuppressives are initially contraindicated.

嗜酸性肉芽肿伴多血管炎（EGPA）是一种与ANCA相关的小血管血管炎，特征是嗜酸性粒细胞增多和嗜酸性哮喘。EGPA涉及威胁生命的器官，特别是心脏和中枢神经系统（CNS），是一种医疗急症，需要立即进行免疫抑制。我们描述了一位患有慢性鼻-鼻窦炎和嗜酸性粒细胞性哮喘病史的58岁患者，该患者出现发烧，嗜酸性粒细胞增多症，全身性炎症和低血压。诊断检查确定了血液培养物中的心脏肿块，中枢神经系统血管炎，中枢神经系统栓塞和金黄色葡萄球菌。患有心脏和中枢神经系统并发金黄色葡萄球菌的活动性EGPA诊断为败血症。为了不影响活性EGPA中的抗菌免疫，将抗生素治疗与抗人IL-5受体α单克隆抗体Benralizumab结合使用。Benralizumab的耐受性良好，并且EGPA的CNS和心脏表现迅速消失，而抗菌免疫没有受到影响。贝那珠单抗可以作为严重禁忌免疫抑制剂的重症患者中嗜酸性粒细胞介导的病理的治疗选择。