Tsubouchi Kazuya, Arimura-Omori Masako, Inoue Shigesato, Okamatsu Yuki, Inoue Katsuhiro, Harada Taishi
Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Fukuoka, Japan.
Respir Med Case Rep. 2021 Jan 5;32:101339. doi: 10.1016/j.rmcr.2021.101339. eCollection 2021.
We herein report a case of allergic bronchopulmonary aspergillosis (ABPA) with marked eosinophilia and high attenuation mucus (HAM) on chest computed tomography (CT), which demonstrated a rapid and remarkable improvement with benralizumab treatment. A 67-year-old Japanese woman, who was diagnosed with asthma at the age of 64 years, was admitted with dyspnea. Her blood test results showed marked eosinophilia (peripheral blood eosinophil count 24403/μL) and elevated serum IgE levels. Chest CT also revealed ground-glass opacity. Sputum cytology detected filamentous fungi, suggesting an infection with . Based on these findings, ABPA was diagnosed. Following systemic corticosteroid treatment, her respiratory symptoms and chest radiography findings showed improvements. However, with the gradual tapering and eventual discontinuance of the corticosteroid therapy, a concomitant increase in the peripheral blood eosinophils and a recurrence of the clinical symptoms, was observed. In addition, her pulmonary function decreased and chest CT revealed worsened bronchial mucus plugs. To control the asthma with ABPA exacerbation, benralizumab was administered. Following treatment with benralizumab, the patient's asthmatic symptoms improved, together with a decrease in her peripheral eosinophil count. Mucus plugs were no longer visible on chest CT. Pulmonary function test result also showed a remarkable improvement. There was no relapse of dyspnea and no reappearance of the mucus plugs. This case suggests that benralizumab may be a suitable treatment option for patients with ABPA with marked eosinophilia and HAM on chest CT.
我们在此报告一例变应性支气管肺曲霉病（ABPA），其胸部计算机断层扫描（CT）显示有明显嗜酸性粒细胞增多和高密度黏液（HAM），使用贝那利珠单抗治疗后病情迅速且显著改善。一名67岁的日本女性，64岁时被诊断为哮喘，因呼吸困难入院。她的血液检查结果显示明显嗜酸性粒细胞增多（外周血嗜酸性粒细胞计数24403/μL）和血清IgE水平升高。胸部CT还显示磨玻璃影。痰细胞学检查发现丝状真菌，提示感染了……基于这些发现，诊断为ABPA。全身使用糖皮质激素治疗后，她的呼吸道症状和胸部X线检查结果有所改善。然而，随着糖皮质激素治疗逐渐减量并最终停药，观察到外周血嗜酸性粒细胞随之增加且临床症状复发。此外，她的肺功能下降，胸部CT显示支气管黏液栓加重。为控制ABPA加重伴发的哮喘，给予贝那利珠单抗治疗。使用贝那利珠单抗治疗后，患者的哮喘症状改善，外周嗜酸性粒细胞计数减少。胸部CT上不再可见黏液栓。肺功能测试结果也显示显著改善。未出现呼吸困难复发，黏液栓也未再次出现。该病例表明，贝那利珠单抗可能是胸部CT显示有明显嗜酸性粒细胞增多和HAM的ABPA患者的合适治疗选择。
