Successful management of recurrent allergic bronchopulmonary aspergillosis after changing from mepolizumab to dupilumab: A case report. (2022)

• Record Type: Journal Article
• Authors: Kai, Yoshiro; Yoshikawa, Masanori; Matsuda, Masayuki; Suzuki, Kentaro; Takano, Masato; Tanimura, Kazuya; Fujioka, Nobuhiro; Fujita, Yukio; Muro, Shigeo
• Is Part Of: Respiratory medicine case reports. Volume 39(2022)
• Publication Date: 2022
• Subjects: Allergic bronchopulmonary aspergillosis -- Dupilumab -- Mepolizumab -- Prednisolone -- IL-4 -- IL-13; ABPA Allergic bronchopulmonary aspergillosis -- ACT Asthma Control Test -- ANCA Antineutrophil cytoplasmic antibody -- CT Computed tomography -- EETosis Eosinophil extracellular trap cell death -- ETosis Extracellular trap cell death -- FEV1 Forced expiratory volume in 1 sec -- ICS Inhaled corticosteroid -- IgE Immunoglobulin E -- ILC2 Group-2 innate lymphoid cells -- IL-5 Interleukin-5 -- LABA Long-acting beta-agonist -- PSL Prednisolone; Respiratory organs -- Diseases -- Periodicals; Chest -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System -- Periodicals; Chest -- Diseases; Respiratory organs -- Diseases; Electronic journals; Periodicals; 616.2
• DOI: 10.1016/j.rmcr.2022.101723
• Languages: English
• ISSNs: 2213-0071

Abstract

Abstract: An 81-year-old woman presented to our hospital due to an abnormal shadow on a chest X-ray and a 4-week-old persistent cough. Laboratory examination revealed increased serum eosinophils and immunoglobulin E. The Asthma Control Test (ACT) score and forced expiratory volume in 1 sec indicated airway obstruction. Chest computed tomography (CT) revealed mucoid impaction in the dilated left-lingular lobar bronchus. She was diagnosed with bronchial asthma and treated with a high-dose inhaled corticosteroid/long-acting β2 agonist. Two months later, her mucoid impaction in the CT image worsened; moreover, bronchoscopy revealed the white mucus plug with Charcot–Leyden crystals and filamentous fungi. The patient was diagnosed with Allergic bronchopulmonary aspergillosis (ABPA) and treatment with 30 mg/day prednisolone was started. Both the blood eosinophil count and the chest image improved almost substantially, and the steroid was discontinued after a year. Sixteen months after cessation of prednisolone treatment, peripheral eosinophilia and mucoid impaction in the left B3b recurred. For the treatment of bronchial asthma and recurrent ABPA, administration of mepolizumab was initiated. Subsequently, although her peripheral eosinophils count decreased, chest CT showed expansion of the mucoid impaction and IgE increased despite mepolizumab treatment. Alternative subcutaneous injection therapy with dupilumab improved chest image, serum IgE level, and her ACT score. After changing from mepolizumab to dupilumab, her ABPA, asthma, and pulmonary function improved remarkably. This case illustrates the potential utility of dupilumab for ABPA without re-administration of oral prednisolone. Additional research is needed to identify an effective therapy for ABPA with asthma. Highlights: Systemic corticosteroids are the standard treatment for ABPA. ABPA often recurs and requires prolonged courses of corticosteroids. We successfully treated a recurrent ABPA case by changing mepolizumab to dupilumab. Dupilumab can be used as an alternative for prednisolone for treating ABPA.