A Case of Allergic Bronchopulmonary Aspergillosis With Failure of Benralizumab and Response to Dupilumab

Abstract

We report a case of a 68-year-old woman who was being treated for bronchial asthma and developed allergic bronchopulmonary aspergillosis (ABPA) that was unresponsive to benralizumab therapy but went into remission with dupilumab therapy. The patient presented with an exacerbation of dry cough and was diagnosed with ABPA based on new diagnostic criteria. Despite the attempted therapeutic intervention, the patient declined to use systemic corticosteroids due to concerns about potential side effects. Subsequently, itraconazole and benralizumab were administered, with temporary relief before relapse. Given the patient's refusal to continue itraconazole and benralizumab, dupilumab was administered as an alternative therapy, which resulted in significant improvement of both symptoms and imaging. Although the use of biological agents for ABPA lacks clear evidence, our results suggest that dupilumab may provide an effective therapeutic strategy.

Keywords: allergic bronchopulmonary aspergillosis; benralizumab; dupilumab; interleukin-13; mucus plug.

Figure 1. Computed tomography image of the chest when the patient was diagnosed with allergic bronchopulmonary aspergillosis

Figure 2. Computed tomography images of the chest (A) during symptom flare-ups two months after the initiation of benralizumab therapy and (B) when imaging findings markedly improved after the administration of dupilumab