Benralizumab in a Patient With Refractory Eosinophilic Endocarditis
Bibliographic record
Abstract
Hypereosinophilic syndrome (HES) is a hematologic disorder characterized by an increased absolute eosinophil count (AEC) that can lead to tissue infiltration and damage. Idiopathic HES (iHES) comprises a subset of patients with HES, in which a reactive cause such as infections or an inflammatory process cannot be identified, and clonality is not demonstrable. iHES remains a challenge to treat since there is no specific mutation to target. Interleukin-5 (IL-5) is a cytokine responsible for the proliferation and maturation of eosinophils. Anti-IL-5 and anti-IL-5 receptor therapies represent recent advancements in the management of these disorders. A 25-year-old female developed transient and recurrent visual deficits lasting several minutes at a time. Marked peripheral blood eosinophilia was noted. Over a year, she developed Loeffler’s endocarditis (LE), leading to microvascular ischemic strokes and heart failure due to mitral valve infiltration. The patient needed an urgent mitral valve replacement. Multiple lines of standard eosinophil-lowering agents were tried and appeared ineffective or could not be maximally dosed due to hematologic dose-limiting toxicity. Benralizumab (Fasenra®) is an IL-5 receptor antagonist indicated for eosinophilic asthma and eosinophilic granulomatosis with polyangiitis (EGPA) but not Food and Drug Administration (FDA)-approved for other HESs. Off-label benralizumab was tried, and her eosinophil count normalized within a week, allowing hemodynamic stability for a mitral valve replacement. After a year of continued bimonthly treatment with off-label benralizumab, her eosinophil count remains within normal limits, resulting in stabilization of her cardiac parameters. Off-label benralizumab treatment was effective in controlling our patient’s eosinophilic counts and preventing further cardiac injury. Benralizumab should be considered earlier in the treatment of LE, particularly when rapid control of the eosinophil count is needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".