Abstract
We report a case of a 53-year-old male hairdresser with refractory asthma clinically diagnosed as eosinophilic granulomatosis with polyangiitis (EGPA) who showed remarkable improvement with tezepelumab after failing mepolizumab therapy. The patient presented with a three-year history of progressive multisystem involvement, including anosmia, asthma, hearing loss, and skin rash. The patient was clinically diagnosed as EGPA based on asthma, sinusitis with nasal polyps, eosinophilia, and purpura. Despite initial improvement with oral corticosteroids and mepolizumab, he experienced recurrent exacerbations of asthma. Tezepelumab was initiated, resulting in significant symptom improvement, successful corticosteroid tapering, and marked enhancement in pulmonary function tests. This case suggests that tezepelumab may be an effective treatment option for patients with refractory asthma, particularly those with suspected occupational exposure. Further research is needed to identify factors that predict response to different biologic therapies in refractory EGPA-related asthma and to explore the potential role of occupational exposures in treatment outcomes.