Case Report: Triple Autoimmune Overlap: Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Hypereosinophilic Asthma with Systemic Manifestations

This case report describes a 44-year-old woman with a rare triple autoimmune overlap of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and hypereosinophilic asthma with systemic manifestations (HASM). Initially managed as ANCA-negative eosinophilic granulomatosis with polyangiitis (EGPA), her condition was reclassified as HASM due to the absence of ANCA and biopsy-proven vasculitis. Treatment with high-dose glucocorticoids, methotrexate, and hydroxychloroquine led to rapid normalization of eosinophils and remission of asthma and sinus disease. The report highlights the importance of evaluating new-onset eosinophilic asthma in patients with rheumatic diseases for EGPA-spectrum or hypereosinophilic disorders, as timely EGPA-type immunosuppression can prevent organ damage.