17th January 2024

A 60-year-old woman presents to A and E with worsening shortness of breath, a new oxygen requirement and sacral oedema.

A 60-year-old woman presents to A and E with worsening shortness of breath, a new oxygen requirement and sacral oedema. She also has had issues over the last few months with arthralgia, myalgia and a purpuric rash on her elbows and knees. She has a background of asthma, depression and previous TIA. On arrival, she is hypotensive, tachycardic and maintaining her oxygen saturations between 90-95% on 35% oxygen via venturi mask. On examination, she appears severely overloaded, with a productive cough and bibasal crackles on auscultation. Her bloods show an eosinophil count of more than 10% of the total white cell count (WCC) and raised inflammatory markers; her chest x-ray shows pulmonary oedema with bilateral pleural effusions, and a TTE shows moderate MR and wall motion abnormalities. She is treated for newly diagnosed decompensated heart failure with IV diuretics and a suspected superimposed chest infection. After review by the rheumatology team, she has been diagnosed with likely EGPA. Which of the below induction regimes would be most appropriate for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.