Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, China.
Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Medicine (Baltimore). 2023 Jun 16;102(24):e33845. doi: 10.1097/MD.0000000000033845.
Pulmonary aspergillosis is a pulmonary infectious disease that is clinically difficult to diagnose and treat. When the lower respiratory tract is invaded by Aspergillus, the clinical manifestations and imaging features vary among patients with different immune states. The use of antifungal drugs and glucocorticoids are important, but some patients do not respond satisfactorily to treatment.
A 59-year-old female had a long history of asthma and poor symptom control, with long-term use of long-acting inhaled glucocorticoids combined with a long-acting β2 receptor agonists (ICS + LABA) (salmeterol fluticasone inhalation powder). The ground glass shadow, tree-in-bud sign, and bronchiectasis in the middle lobe of the right lung and the lower lobe of both lungs were first detected by chest CT over 5 years ago. Atelectasis in the middle lobe of the right lung was detected over 3 years ago. Over 2 years ago, the patient was hospitalized and a repeat chest CT showed persistent atelectasis in the middle lobe of the right lung, and more lesions in bilateral lower lungs than before. Aspergillus fumigatus was detected in alveolar lavage fluid and sputum pathogenic culture, which confirmed the diagnosis of pulmonary aspergillosis. After treatment with voriconazole and amphotericin B, the middle lobe of the right lung partially reopened, but the lesions in bilateral lower lungs persisted. After 21 weeks of treatment, the antifungal drugs were stopped because the patient refused to use oral/intravenous glucocorticoids, and omalizumab was finally chosen for treatment. After 1 month of treatment, the patient's clinical symptoms began to ease. After 1 year of treatment, imaging reexamination of lung showed that the lesions were completely cleared, accompanied by significant improvement in nutritional status and airway function.
We reported the case of a patient with pulmonary Aspergillus infection who was treated with omalizumab and showed significant improvement in clinical symptoms and imaging abnormalities, which provides a new option for patients with pulmonary Aspergillus infection who show unsatisfactory response with first-line drugs.
肺曲霉病是一种临床诊断和治疗都很困难的肺部感染性疾病。当呼吸道下部被曲霉菌侵犯时，不同免疫状态的患者临床表现和影像学特征存在差异。抗真菌药物和糖皮质激素的应用非常重要，但部分患者治疗效果并不满意。
一名 59 岁女性，有哮喘病史，且症状控制不佳，长期使用长效吸入性糖皮质激素联合长效β2 受体激动剂（ICS+LABA）（沙美特罗氟替卡松吸入粉）。5 年前首次发现胸部 CT 显示两肺中下叶及右肺中叶磨玻璃影、树芽征及支气管扩张，3 年前发现右肺中叶肺不张，2 年前再次住院，复查胸部 CT 显示右肺中叶持续肺不张，双肺下叶较前增多病灶。肺泡灌洗液和痰培养检测到烟曲霉，确诊为肺曲霉病。经伏立康唑和两性霉素 B 治疗后，右肺中叶部分复张，但双肺下叶病灶仍持续存在。由于患者拒绝使用口服/静脉糖皮质激素，抗真菌药物治疗 21 周后停药，最终选择奥马珠单抗治疗。治疗 1 个月后，患者的临床症状开始缓解。治疗 1 年后，肺部影像学复查显示病变完全清除，营养状况和气道功能明显改善。
我们报道了一例肺曲霉感染患者使用奥马珠单抗治疗后临床症状和影像学异常明显改善的病例，为一线药物治疗效果不理想的肺曲霉感染患者提供了新的选择。
