Case Report: Severe ANCA-positive eosinophilic granulomatosis with polyangiitis presenting with Loeffler endocarditis and cryofibrinogenemia-associated digital gangrene successfully treated with rituximab

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare ANCA-associated vasculitis characterized by asthma and eosinophilia.
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A 37-year-old woman with EGPA developed severe complications including digital gangrene and Loeffler endocarditis despite aggressive treatment.
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Rituximab treatment resulted in a positive clinical response and sustained remission after the patient's complex disease course.
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The case highlights the interplay between eosinophilic inflammation, ANCA-mediated vasculitis, and cryofibrinogenemia in severe ischemic complications.
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This presentation of EGPA with digital gangrene and Loeffler endocarditis associated with MPO-ANCA positivity is previously unreported.

Frontiers In Immunology

by Irena Ostric Pavlovic, Danijela Trifunovic-Zamaklar, Branka Bonaci-Nikolic, Mileva Bascarevic, Vesna Tomic-Spiric, Aleksandra Peric-Popadic, Natasa Dragasevic Miskovic, Boris Ukropina, Aleksandar Reljic, Natasa Kusic, Andrija Pavlovic, Antonije Velickovic, Sara Radovic, Snezana Arandjelovic
July 7, 2026

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