使用阿达木单抗治疗的强直性脊柱炎患者并发变应性支气管肺曲霉病。
Allergic bronchopulmonary aspergillosis in a patient with ankylosing spondylitis treated with adalimumab.
作者信息
Suzuki Yudai, Takasaka Naoki, Matsubayashi Sachi, Kojima Ayako, Shinfuku Kyota, Hasegawa Tsukasa, Yamada Masami, Fujisaki Ikumi, Seki Aya, Seki Yoshitaka, Ishikawa Takeo, Kuwano Kazuyoshi
机构信息
Division of Respiratory Diseases, Department of Internal Medicine The Jikei University Daisan Hospital Tokyo Japan.
Division of Respiratory Diseases, Department of Internal Medicine The Jikei University Hospital Tokyo Japan.
出版信息
Respirol Case Rep. 2021 Jun 23;9(8):e00805. doi: 10.1002/rcr2.805. eCollection 2021 Aug.
We herein report a case of allergic bronchopulmonary aspergillosis (ABPA) that occurred in a man treated with adalimumab for ankylosing spondylitis (AS). A 69-year-old man with a history of ankylosing spondylitis treated by adalimumab, an anti-tumour necrosis factor-α (TNF-α) antibody, developed cough and wheezing. Chest computed tomography showed obstruction of dilated left upper lobe bronchus by high attenuation mucus as well as central bronchiectasis. Both -specific immunoglobulin E (IgE) and precipitating antibody were positive and was detected in a sputum culture. According to the new diagnostic criteria, the patient was diagnosed with ABPA. His condition rapidly improved after the withdrawal of adalimumab and initiation of prednisolone and itraconazole. Anti-TNF-α antibody might cause ABPA through both aggravation of the host's T-helper 2 immunological response and anti-fungal response.
我们在此报告一例强直性脊柱炎（AS）患者在接受阿达木单抗治疗后发生变应性支气管肺曲霉病（ABPA）的病例。一名69岁有强直性脊柱炎病史的男性，接受抗肿瘤坏死因子-α（TNF-α）抗体阿达木单抗治疗后，出现咳嗽和喘息。胸部计算机断层扫描显示左肺上叶扩张支气管被高密度黏液阻塞以及中心性支气管扩张。特异性免疫球蛋白E（IgE）和沉淀抗体均为阳性，痰培养检测到曲霉。根据新的诊断标准，该患者被诊断为ABPA。停用阿达木单抗并开始使用泼尼松龙和伊曲康唑后，他的病情迅速改善。抗TNF-α抗体可能通过加重宿主的辅助性T细胞2免疫反应和抗真菌反应而导致ABPA。
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