Ustekinumab associated chronic eosinophilic pneumonia. (2nd December 2021)

• Record Type: Journal Article
• Authors: Kalra, Saminder Singh; Chizinga, Mwelwa; Trillo-Alvarez, Cesar; Papierniak, Eric S.
• Is Part Of: Journal of asthma. Volume 58:Number 12(2021)
• Page Start: 1670
• Page End: 1674
• Publication Date: 2021-12-02
• Subjects: Case reports -- rhinitis/sinusitis -- treatment -- pharmacotherapy; Asthma -- Periodicals; 616.238005
• DOI: 10.1080/02770903.2020.1827416
• Languages: English
• ISSNs: 0277-0903

Abstract

Abstract: Introduction: Ustekinumab-induced eosinophilic pneumonia is rare and to our knowledge, this is the fifth reported case of such an entity. Case study: A 60-year-old female was admitted with worsening shortness of breath and a nonproductive cough for 4 months. Her past medical history was significant for Crohn's disease and psoriatic arthritis that was previously managed with adalimumab and switched to ustekinumab 2 months before symptoms. Initial diagnostic workup showed 10% peripheral eosinophilia and a CT chest showed numerous 5 mm nodules scattered throughout the lungs along with some peripheral reticulations. Her BAL fluid analysis showed abnormally high eosinophil count (67%), greatly limiting her potential diagnoses to eosinophilic pneumonia, EGPA, and tropical pulmonary eosinophilia (TPE). AEP typically causes more severe disease with a rapid onset, and there was low suspicion for TPE based on history, leaving EGPA and CEP. Based on her negative autoimmune serology, a negative biopsy of the nasal mucosa (no vasculitis/granulomata or eosinophils), and negative infectious workup, the patient was diagnosed with CEP secondary to ustekinumab and the drug was stopped. She was started on high dose prednisone and after a prolonged taper over 5 months, her symptoms and nodules and reticulations on her CT scan resolved. Discussion: This case exemplifies the importance of identifying drug-induced lung diseases which in many cases might not have a strong temporal association with the symptom onset. It also highlights that some drugs owing to their long elimination half-time can remain in the system for a prolonged period and continues to cause symptoms despite their cessation and require prolonged treatment and reassurance. Conclusion: The association of eosinophilic pneumonia with ustekinumab, a drug used in the treatment of psoriasis and other autoimmune diseases, is rare and there is a paucity of literature regarding this association.