Kisling Adam, Jones Jason, Hixson Caleb, Hostler David, Hostler Jordanna
Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA.
Department of Pathology, Tripler Army Medical Center, Honolulu, HI, USA.
Drugs Context. 2020 Aug 18;9. doi: 10.7573/dic.2020-5-3. eCollection 2020.
A 55-year-old woman with cough-variant asthma presented for 1 month of worsening wheezing, cough, and dyspnea refractory to treatment. Initial laboratory findings revealed profound peripheral eosinophilia, and a chest computed tomography showed bi-apical consolidation. Bronchio-alveolar lavage demonstrated alveolar eosinophilia. She was diagnosed with idiopathic chronic eosinophilic pneumonia (ICEP). Her peripheral eosinophilia and respiratory symptoms improved rapidly with high-dose systemic corticosteroid therapy. However, she was intolerant to corticosteroid monotherapy due to non-compliance and psychological adverse effects. Mepolizumab was initiated as a steroid-sparing agent, resulting in successful therapy for 2 years without relapse or adverse effects. Mepolizumab is an interleukin-5 (IL-5) antagonist monoclonal antibody, which is a targeted therapy for diseases mediated by eosinophil activity and eosinophil proliferation. Mepolizumab is typically used in ICEP refractory to steroids, but this case supports its use in cases of glucocorticoid intolerance. Further study of IL-5 antagonist therapies for ICEP may identify an alternative treatment modality for patients in whom the adverse effects of corticosteroids pose a challenge.
一名55岁的咳嗽变异性哮喘女性患者，因喘息、咳嗽和呼吸困难加重1个月前来就诊，这些症状对治疗无效。初始实验室检查结果显示外周血嗜酸性粒细胞显著增多，胸部计算机断层扫描显示双肺尖实变。支气管肺泡灌洗显示肺泡嗜酸性粒细胞增多。她被诊断为特发性慢性嗜酸性粒细胞性肺炎（ICEP）。高剂量全身糖皮质激素治疗后，她的外周血嗜酸性粒细胞增多和呼吸道症状迅速改善。然而，由于不依从和心理不良反应，她无法耐受糖皮质激素单药治疗。开始使用美泊利单抗作为糖皮质激素减量药物，治疗成功持续2年，无复发或不良反应。美泊利单抗是一种白细胞介素-5（IL-5）拮抗剂单克隆抗体，是针对由嗜酸性粒细胞活性和嗜酸性粒细胞增殖介导的疾病的靶向治疗药物。美泊利单抗通常用于对糖皮质激素难治的ICEP，但该病例支持其在糖皮质激素不耐受的病例中的应用。对ICEP的IL-5拮抗剂疗法的进一步研究可能会为糖皮质激素不良反应构成挑战的患者确定一种替代治疗方式。
