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Case Reports
. 2018 Nov 24:26:59-62.
doi: 10.1016/j.rmcr.2018.11.013. eCollection 2019.

Allergic bronchopulmonary aspergillosis successfully treated with mepolizumab: Case report and review of the literature

Shuko Hirota  1 , Yoichi Kobayashi  1 , Takashi Ishiguro  1 , Takashi Nishida  1 , Naho Kagiyama  1 , Yoshihiko Shimizu  2 , Noboru Takayanagi  1
Affiliations
Case Reports

Allergic bronchopulmonary aspergillosis successfully treated with mepolizumab: Case report and review of the literature

Shuko Hirota et al. Respir Med Case Rep. .

Abstract

A 56-year-old woman was referred to our hospital for recurrent asthma of 20 years duration. She was diagnosed as having allergic bronchopulmonary aspergillosis on the basis of clinical symptoms, peripheral blood eosinophilia, elevated total serum immunoglobulin E value, positive results of specific IgE and precipitating antibodies against Aspergillus sp., central bronchiectasis, and mucoid impaction. Systemic corticosteroids and anti-fungal therapy improved her symptoms, but the cessation of these treatments led to frequent exacerbations. Omalizumab improved her asthmatic symptoms to the point that corticosteroids could be stopped; however, radiological findings were not improved, and coexisting eosinophilic sinusitis and otitis media worsened. After her treatment was changed from omalizumab to mepolizumab, not only her asthmatic symptoms but also her sinusitis and otitis media became well controlled, and chest radiological findings improved.

Keywords: Allergic bronchopulmonary aspergillosis; Corticosteroid; Itraconazole; Mepolizumab; Omalizumab.

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Figures

Fig. 1
Fig. 1
Radiological findings on admission. Chest X-ray showed bilateral bronchial wall thickening (A), and CT showed central bronchiectasis, high-attenuation mucoid impaction (arrow) (B), and centrilobular opacities and nodules (C).
Fig. 2
Fig. 2
Bronchoscopy findings. Mucoid plugs were found in several bronchi.
Fig. 3
Fig. 3
Histopathological findings. Photograph shows mucus plugs (A). Mucus plugs contained many eosinophils and Charcot-Leyden crystals (B).
Fig. 4
Fig. 4
Radiological findings over the clinical course showed improvement (A: before mepolizumab, B: after mepolizumab).
See this image and copyright information in PMC

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