Lee W, Teo F S W, Santosa A, Teng G G
University Medicine Cluster, Internal Medicine Residency, National University Health System, Singapore.
University Medicine Cluster, Division of Respiratory and Critical Care Medicine, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
Eur Ann Allergy Clin Immunol. 2015 Nov;47(6):228-31.
A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.
一名61岁的中国男性，患有长期稳定的嗜酸性肉芽肿性多血管炎（EGPA）和哮喘，出现急性低氧血症和阻塞性肺功能下降。血清IgE水平升高、烟曲霉特异性IgE阳性以及中央支气管扩张伴小气道黏液嵌塞的CT表现证实了变应性支气管肺曲霉病（ABPA）的新发展。EGPA的维持治疗药物硫唑嘌呤被停用。泼尼松龙0.5mg/kg/天和伊曲康唑改善了他的症状和IgE水平。据我们所知，尚未有EGPA患者发生ABPA的报道。本文讨论了EGPA伴哮喘发作、ABPA与曲霉超敏反应性哮喘之间的鉴别。以嗜酸性粒细胞为核心的Th2免疫增强可能与这些情况有关。
