Complete withdrawal of glucocorticoids after dupilumab therapy in allergic bronchopulmonary aspergillosis:A case report  

作　　者：Tadashi Nishimura Tomohito Okano Masahiro Naito Chikashi Tsuji Soichi Iwanaka Yasumasa Sakakura Taro Yasuma Hajime Fujimoto Corina N D'Alessandro-Gabazza Yasuhiro Oomoto Tetsu Kobayashi Esteban C Gabazza Hidenori Ibata 

机构地区：[1]Department of Pulmonary Medicine,Mie Chuo Medical Center,Tsu 514-1101,Mie,Japan [2]Department of Pulmonary and Critical Care Medicine,Mie University,Tsu 514-8507,Mie,Japan [3]Department of Immunology,Mie University School of Medicine,Mie University,Tsu 514-8507,Mie,Japan [4]Department of Pulmonary and Critical Care Medicine,Graduate School of Medicine Mie,Mie University,Tsu 514-8507,Mie,Japan

出　　处：《World Journal of Clinical Cases》2021年第23期6922-6928,共7页世界临床病例杂志

摘　　要：BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.

关 键 词：Allergic bronchopulmonary aspergillosis Dupilumab ASTHMA INTERLEUKIN-13 INTERLEUKIN-4 Case report 

分 类 号：R519.8[医药卫生—内科学]