Toshiwakai Clinic, Toshiwakai, Nagoya 460-0022, Japan.
Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan.
Int J Mol Sci. 2021 Oct 18;22(20):11209. doi: 10.3390/ijms222011209.
A woman in her 50s was a super responder to benralizumab administered for the treatment of severe bronchial asthma (BA) with eosinophilic chronic rhinosinusitis with nasal polyp (ECRS) and eosinophilic otitis media (EOM). She exhibited the gradual exacerbation of ECRS/EOM despite good control of BA approximately 1 year after benralizumab initiation. Therefore, the treatment was switched to dupilumab, and the condition of the paranasal sinuses and middle ear greatly improved with the best control of her asthma. The patient reported that her physical condition was the best of her life. However, she developed a pulmonary opacity on chest computed tomography after 6 months. Histological examination of the lung parenchyma and cell differentiation of the bronchoalveolar lavage fluid indicated atypical chronic eosinophilic pneumonia, and treatment was switched to mepolizumab. Similarly to the period of benralizumab treatment, exacerbation of ECRS/EOM reduced her quality of life approximately 10 months after the administration of mepolizumab. Dupilumab was again introduced as a replacement for mepolizumab. The clinical course and consideration of the interaction between inflammatory cells led us to speculate that interleukin-13 could play a key role in the development of ECRS/EOM with severe BA.
一位 50 多岁的女性患者因严重支气管哮喘（BA）伴嗜酸性慢性鼻-鼻窦炎伴鼻息肉（ECRS）和嗜酸性中耳炎（EOM）接受贝那利珠单抗治疗，成为超级应答者。贝那利珠单抗治疗开始后约 1 年，尽管 BA 得到良好控制，但她仍逐渐出现 ECRS/EOM 恶化。因此，治疗方案转换为度普利尤单抗，副鼻窦和中耳状况大大改善，哮喘得到最佳控制。患者报告称她的身体状况是一生中最好的。然而，在接受 6 个月后，她的胸部计算机断层扫描显示肺部不透明。肺实质的组织学检查和支气管肺泡灌洗液的细胞分化表明为非典型慢性嗜酸性肺炎，并将治疗方案转换为美泊利珠单抗。与贝那利珠单抗治疗期间相似，在接受美泊利珠单抗治疗大约 10 个月后，ECRS/EOM 恶化再次降低了她的生活质量。再次引入度普利尤单抗作为美泊利珠单抗的替代品。临床过程和对炎症细胞相互作用的考虑使我们推测白细胞介素-13可能在严重 BA 伴 ECRS/EOM 的发展中发挥关键作用。
