Tezepelumab treatment for allergic bronchopulmonary aspergillosis

Abstract

An 82-year-old man had been diagnosed with asthma. He experienced repeated exacerbations requiring treatment with a systemic corticosteroid despite being treated with medications including high-dose fluticasone furoate/umeclidinium/vilanterol, montelukast sodium, and theophylline; treatment with mepolizumab was then initiated. The patient had been free from exacerbations for 15 months; however, he suffered from post-obstructive pneumonia and atelectasis secondary to mucoid impaction in the right middle lobe of the lung, accompanied by a productive cough, wheezing, dyspnea, and right chest pain. In addition to the development of mucus plugs, the levels of serum IgE specific to Aspergillus spp. became positive; a definite diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was established. The patient underwent treatment with tezepelumab. Over 3 months, the mucus plugs and pulmonary opacities diminished gradually in parallel with the improvement in the control of asthmatic symptoms. Tezepelumab might provide a novel steroid-sparing strategy for the management of ABPA, although further studies are required.

Keywords: allergic bronchopulmonary aspergillosis; asthma; mepolizumab; mucoid impaction; tezepelumab.

FIGURE 1

Computed tomography images of the chest (A) before the administration of mepolizumab, (B) when developing allergic bronchopulmonary aspergillosis during mepolizumab treatment, and (C) 3 months after initiating treatment with tezepelumab. Arrowheads indicate central bronchiectasis. High‐attenuation mucus plugs in the right middle lobe of the lung (white arrows), accompanied by atelectasis (dotted lines), were attenuated after the initiation of tezepelumab therapy