How would you approach treatment of suspected EGPA presenting with progressive neuropathy and sural nerve biopsy with eosinophilia, but no evidence of vasculitis?
Eosinophils 7300, IgE 3802, RF >650, low C4, MPO/PR3 negative. Sural Nerve Biopsy: prominent eosinophilic infiltration of the epineurium, perineurium, and endoneurium with occasional small-vessel involvement, but no definite vasculitis. CTA chest/abdomen/pelvis was negative and infectious/neurologic workup including CSF and MRI brain/spine were unrevealing. The patient received pulse dose steroids, but has persistent motor deficits. Would you favor escalation to Rituximab or utilize IVIG in this setting?