因肺孢子菌肺炎导致美泊利珠单抗控制的重度支气管哮喘难治性发作：一例报告
Refractory flare-up of severe bronchial asthma controlled with mepolizumab due to Pneumocystis pneumonia: a case report.
作者信息
Takeda Kazuya, Sumi Toshiyuki, Nagahisa Yuta, Matsuura Keigo, Sekikawa Motoki, Watanabe Hiroki, Yamada Yuichi, Chiba Hirofumi
机构信息
Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan.
Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.
出版信息
Allergy Asthma Clin Immunol. 2022 Apr 23;18(1):35. doi: 10.1186/s13223-022-00678-y.
BACKGROUND
Biologics dramatically improve symptoms of severe asthma; however, various exacerbating factors may induce flare-up. Pneumocystis spp. have not been reported as a cause of asthma exacerbation during biologic use, although patients with severe asthma have high levels of antibodies against Pneumocystis spp.
CASE PRESENTATION
An 87-year-old female with severe asthma that was well-controlled with mepolizumab, who developed a steroid-resistant refractory flare-up. Chest computed tomography showed bilateral ground glass opacities, and results of polymerase chain reaction tests on induced sputum were positive for Pneumocystis DNA. Therefore, a diagnosis of Pneumocystis pneumonia was made. The clinical symptoms improved after treatment with sulfamethoxazole-trimethoprim.
CONCLUSION
Clinicians should be aware of Pneumocystis pneumonia as a cause of refractory exacerbation of bronchial asthma during use of interleukin-5 inhibitors.
背景
生物制剂可显著改善重度哮喘症状；然而，多种加重因素可能引发病情复发。尽管重度哮喘患者体内抗肺孢子菌属的抗体水平较高，但在使用生物制剂期间，尚未有肺孢子菌属导致哮喘加重的报道。
病例介绍
一名87岁女性，重度哮喘，使用美泊利珠单抗病情得到良好控制，后出现对类固醇耐药的难治性病情复发。胸部计算机断层扫描显示双侧磨玻璃影，诱导痰聚合酶链反应检测结果显示肺孢子菌DNA呈阳性。因此，诊断为肺孢子菌肺炎。使用复方磺胺甲恶唑治疗后临床症状改善。
结论
临床医生应意识到在使用白细胞介素-5抑制剂期间，肺孢子菌肺炎可能是支气管哮喘难治性加重的原因。
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