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Case Reports
. 2024 Jun 11:11:1381261.
doi: 10.3389/fmed.2024.1381261. eCollection 2024.

Tezepelumab improved chronic eosinophilic pneumonia in severe asthma patients with liver cirrhosis

Mizuki Inaba  1 , Yasuo Shimizu  1   2 , Yusuke Nakamura  1 , Hiroaki Okutomi  1 , Akihiro Takemasa  1   2 , Seiji Niho  1
Affiliations
Case Reports

Tezepelumab improved chronic eosinophilic pneumonia in severe asthma patients with liver cirrhosis

Mizuki Inaba et al. Front Med (Lausanne). .

Abstract

Systemic administration of corticosteroids is used in the treatment of chronic eosinophilic pneumonia (CEP). However, in patients with CEP as well as other comorbidities, the adverse effects of corticosteroids should be minimized as much as possible. A 71-year-old woman was presented with aggravating asthma with CEP and sinusitis, and she had uncompensated liver cirrhosis (LC) with a Child-Pugh score of 7. Initial treatment with a low dose of oral corticosteroids (OCSs) in combination with tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) antibody, resulted in rapid improvement of asthma and CEP without deteriorating LC. Sinusitis also improved after ceasing OCS. This case suggested that tezepelumab may be useful as a treatment option for patients with CEP, especially those with liver dysfunction.

Keywords: asthma; eosinophilia; eosinophilic pneumonia; liver fibrosis; oral corticosteroids; sinusitis; tezepelumab; thymic stromal lymphopoietin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Chest X-ray (A) and chest CT (B–D) on the day of the first visit to the hospital. Bilateral ground-glass opacities in the upper lobes and bronchial wall thickening in the lower lobes. Chest X-ray on day 10 from starting therapy (H). Bilateral ground-glass opacities disappeared. Chest CT performed 1 month after starting therapy (E–G). Bilateral ground-glass opacities and bronchial wall thickening disappeared. Sinus CT on the day of the first visit to the hospital (I). Bilateral sinusitis exists in the maxillary sinus. Sinus CT 3 months after starting therapy (J). Bilateral sinusitis was improved.
Figure 2
Figure 2
Clinical course of therapy for the present case. Initial therapy was started (day 0) with the combination of oral corticosteroid (prednisolone, 10 mg/day), inhaled fluticasone furoate/vilanterol (FF/VI, 200/25 μg/day), and tezepelumab (210 mg/month). Prednisolone was administered at 10 mg/day for 10 days. Then, the dose was reduced to 8 mg/day and continued for 1 month before being reduced to 3 mg/day during the next month. Two months after starting treatment, prednisolone was discontinued, while FF/VI and tezepelumab were continued.
Figure 3
Figure 3
Clinical course of the parameters. (A) Asthma control test (ACT), (B) mean change from the baseline score of the asthma control questionnaire (ACQ-5), (C) forced expiratory volume in 1 s, (D) fractional exhaled nitric oxide (FeNO), (E) peripheral eosinophil count, and (F) NH3 in peripheral blood. Baseline: measured on day 0, before starting therapy.
See this image and copyright information in PMC

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