Ruby Sharma Dhital v. HHS - Influenza, eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss) (2025)

Ruby Sharma Dhital, a 27-year-old adult, received an influenza vaccine on October 1, 2019. Twelve days later, she developed symptoms including a cough, fever, joint pain, and a rash, which progressed over the following weeks.

She was hospitalized and eventually diagnosed with Eosinophilic Granulomatosis with Polyangiitis (EGPA), also known as Churg-Strauss syndrome, a rare autoimmune disorder involving inflammation of blood vessels and eosinophils. Petitioner alleged that the flu vaccine caused-in-fact her EGPA, or significantly aggravated a pre-existing condition.

Petitioner presented medical records and expert testimony from Dr. M.

Eric Gershwin and Dr. Jordan Fein, who opined that the flu vaccine likely accelerated her EGPA by unmasking it and promoting a proinflammatory cytokine response.

Respondent, the Secretary of Health and Human Services, contested entitlement, presenting expert testimony from Dr. Mehrdad Matloubian and Dr.

Frederic F. Little.

Respondent's experts argued that Petitioner's condition was more consistent with Granulomatosis with Polyangiitis (GPA) than EGPA, citing factors such as the absence of asthma, the presence of anti-PR3 antibodies, and renal involvement. They further contended that there was no established medical theory or evidence to support the claim that the flu vaccine could cause or accelerate EGPA, particularly in the absence of a clear prodromal phase of the disease prior to vaccination.

The court found that Petitioner did not likely have EGPA and had not carried her burden of proof to establish significant aggravation, concluding that the evidence preponderated against her proposed diagnosis and causal theory. Therefore, entitlement to compensation was denied.