John Lawrence Finally Gets a Diagnosis
On Sept. 28, 2024, at age 65, John Lawrence broke the USA Powerlifting Texas State Raw Bench Press Championship record in his age class. Four years earlier, he was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome.
EGPA is an extremely rare disease characterized in its early stages by airway inflammation that presents as asthma or rhinitis. Later, abnormally high numbers of eosinophils (a type of white blood cell) cause tissue damage, particularly to the lungs, sinuses and digestive tract. The disease progresses to vasculitis, causing organ damage.
Like most people with EGPA, Lawrence had symptoms for a few years before he was diagnosed. “Diagnosis of EGPA is often difficult because the various treatments a patient has had along the way can suppress the medical findings,” says Martin J. Citardi, MD, professor and chair of the Department of Otorhinolaryngology and vice dean for clinical technology at McGovern Medical School at UTHealth Houston. “In John’s case, we reached the diagnosis based on a combination of symptoms, testing, and the knowledge and teamwork of his physician team at UTHealth.”
Lawrence started coughing up solid yellow mucus in December 2016 – his first symptoms. “Otherwise, I didn’t feel bad,” he says. “I was running and working out – and coughing up mucus several times a day. When it continued to worsen, I went to an ENT who ran some tests and didn’t find anything, but he prescribed a combination antihistamine-steroid nasal spray that temporarily mitigated the symptoms. I went along about the same for a while. I would feel better and then get worse.”
In late summer of 2017, he started wheezing in addition to coughing and was referred to an allergist, who prescribed allergy shots and an inhaler. Over the next few months, he managed his daily life on various nasal sprays and inhalers. He also tried XHANCE®, a prescription steroid nasal spray for nasal polyps.
“Things weren’t quite right, and the symptoms came back,” Lawrence says. “In late 2018, I was in bad shape, so we did a CT scan, which showed severe sinus disease. My ENT put me on antibiotics and prednisone, and it cleared up. I felt better than I’d felt in a year. My energy level was up, and I could breathe without coughing.”
To further manage the sinus disease, he underwent sinus surgery in the spring of 2019. “Twenty-one days after I stopped the prednisone and antibiotics, my symptoms came roaring back,” he says. “That cycle of symptoms recurring 21 days after stopping prednisone repeated multiple times.”
He was then referred him to Dr. Citardi, who performed revision functional endoscopic sinus surgery in January 2020. “After the surgery, I stopped the prednisone and sure enough, 21 days later I had symptoms again,” Lawrence says. “By April 2020, I was in worse shape than ever. I did a televisit with Dr. Citardi, who said, ‘I think you may have Churg-Strauss syndrome.’”
Dr. Citardi referred him to Mark Warner, MD, an associate professor of pulmonary medicine. After reviewing the results of a new CT scan of his sinuses and lungs, Dr. Warner thought the image looked like eosinophilic pneumonia. A bronchoscopy confirmed the diagnosis.
“He prescribed 50 milligrams a day of prednisone and that knocked my symptoms down pretty quickly,” Lawrence says.
He also started seeing rheumatologist Courtney McCray, MD, an associate professor of internal medicine at the medical school, who confirmed the diagnosis of EGPA. Over the next year, she prescribed prednisone and gradually reduced the dosage. When symptoms returned at low doses of prednisone, McCray prescribed mepolizumab (Nucala®), the only FDA-approved medication for the disease, which works by regulating the eosinophils.
“Dr. Citardi said yes, Dr. Warner said yes, and Dr. McCray confirmed the diagnosis,” says Lawrence, who uses a mometasone furoate (Asmanex®) inhaler, takes montelukast, and does a twice-daily sinus wash with budesonide, a steroid, to keep the nasal polyps under control. He has been symptom free for more than two years.
“When Dr. McCray prescribed Nucala, it made all the difference in the world,” Dr. Citardi says.
Lawrence was able to stop taking prednisone in August 2022, allowing him to compete in powerlifting without performance-enhancing drugs, which include steroids. He tried looking up an old friend who continued to powerlift into his 70s. “After seeing some of my friend’s records online, I began to think I could break the state raw bench press record,” says Lawrence, now 66. “I joined a gym and started training to get in shape to compete.”
In September 2024, he broke the record for the age 65-to-69 class by bench pressing 130 kilograms – about 286 pounds – without support equipment or performance-enhancing drugs. “My strength had declined over the past few years, and I wondered if it was due to aging or to the EGPA. Because I was able to break a state record, I’m going to go out on a limb and guess that my strength loss was mostly due to normal aging,” he says.
Lawrence works out five days a week, lifts three days a week, and bench presses once a week. He sees Dr. Citardi in follow-up every three months and schedules visits with his pulmonologist and rheumatologist at longer intervals, as needed.
“I think I can break my record and lift over 300 pounds now,” he says. “I’m grateful to Dr. Citardi and my other doctors at UTHealth. Without their care, I couldn’t have set and accomplished that goal.”