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Benralizumab for corticosteroid-refractory DRESS in two COVID-19 patients

Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare severe drug hypersensitivity reaction. Treatment of DRESS currently consists of systemic corticosteroids. Here, we report benralizumab (Fasenra®) as a treatment for corticosteroid-refractory DRESS occurring in two severely ill COVID-19 patients. Both patients received high-dose intravenous corticosteroids for 4-6 days, but cutaneous symptoms, eosinophilia and signs of related organ damage were deteriorating. Based on its successful use in PDGFRA-independent hypereosinophilia, we decided to treat our patients with benralizumab. The patients showed clinical improvement and a rapid substantial drop in eosinophils. Targeted high-throughput serum proteomics prior vs. after treatment revealed a significant reduction mostly in eosinophil- and T cell response-related proteins (a.e. IL-5, CD8, TNF and PD-L1), thus pointing towards an impact of benralizumab on the (drug-directed) T cell response in DRESS.