Kagoshima Hiroki, Hori Ryusuke, Kojima Tsuyoshi, Okanoue Yusuke, Taguchi Atsushi, Yamamoto Hirotaka, Hasebe Koki, Shoji Kazuhiko
Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Otolaryngology, Tenri Hospital, Nara, Japan.
Respir Med Case Rep. 2020 Jun 17;30:101135. doi: 10.1016/j.rmcr.2020.101135. eCollection 2020.
Eosinophilic chronic rhinosinusitis (ECRS) is characterized by the presence of nasal polyps, dominant ethmoid shadows in computed tomography (CT) scans, and elevated levels of eosinophil infiltration into the nasal polyps and peripheral blood. ECRS is often accompanied by severe asthma. The recent development of monoclonal antibody-based biologics, including benralizumab, has offered new therapeutic approaches for the treatment of asthma and allergic diseases. Asthma and ECRS are closely related; hence, benralizumab could provide clinical benefit in ECRS patients with severe asthma. Herein, we report a case of a 47-year-old female patient with severe asthma that presented with nasal obstruction and hearing impairment. Nasal endoscopic and otoscopic examinations indicated the presence of bilateral nasal polyps in the middle nasal meatus, as well as a bilateral effusion in the tympanic cavity. Sinus and temporal CT images showed dominant ethmoid sinus and tympanic cavity shadows. Biopsy of nasal polyps revealed high numbers of eosinophils, which led to the diagnosis of ECRS; eosinophilic otitis media (EOM) with hypereosinophilia was also suspected. Treatment with benralizumab reduced the number of peripheral blood eosinophils and improved asthma symptoms. Prolonged benralizumab administration also resulted in a remarkable size reduction in bilateral middle nasal polyps and aeration of the tympanic cavity. In conclusion, benralizumab treatment improved the symptoms of severe asthma, ECRS, and EOM. Eosinophil depletion could be an important mechanism by which benralizumab improves ECRS and EOM. The use of benralizumab for the treatment of ECRS and EOM patients with severe asthma merits further investigation in large-cohort studies.
嗜酸性粒细胞性慢性鼻-鼻窦炎（ECRS）的特征为存在鼻息肉、计算机断层扫描（CT）显示筛窦阴影占优势，以及鼻息肉和外周血中嗜酸性粒细胞浸润水平升高。ECRS常伴有重度哮喘。包括贝那利珠单抗在内的基于单克隆抗体的生物制剂的最新进展为哮喘和过敏性疾病的治疗提供了新的治疗方法。哮喘与ECRS密切相关；因此，贝那利珠单抗可能对合并重度哮喘的ECRS患者有临床益处。在此，我们报告一例47岁患有重度哮喘的女性患者，该患者出现鼻塞和听力障碍。鼻内镜和耳镜检查显示双侧中鼻道有鼻息肉，以及双侧鼓室积液。鼻窦和颞骨CT图像显示筛窦和鼓室阴影占优势。鼻息肉活检显示大量嗜酸性粒细胞，从而诊断为ECRS；还怀疑患有嗜酸性粒细胞增多性中耳炎（EOM）。使用贝那利珠单抗可减少外周血嗜酸性粒细胞数量并改善哮喘症状。长期使用贝那利珠单抗还导致双侧中鼻息肉明显缩小以及鼓室通气改善。总之，贝那利珠单抗治疗改善了重度哮喘、ECRS和EOM的症状。嗜酸性粒细胞耗竭可能是贝那利珠单抗改善ECRS和EOM的重要机制。在大型队列研究中进一步研究贝那利珠单抗用于治疗合并重度哮喘的ECRS和EOM患者的疗效很有必要。
