Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6922
Peer-review started: April 25, 2021
First decision: June 6, 2021
Revised: June 8, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: August 16, 2021
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.
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.
This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.
Core Tip: Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to antigen from Aspergillus species that causes exacerbation of bronchial asthma, eosinophilic pneumonia, and bronchiectasis. Conventional therapy includes the administration of oral glucocorticoids and other antiasthmatic therapy. However, there are intractable cases showing repeated clinical exacerbations of bronchial asthma despite therapy with oral glucocorticoids. Previous reports have shown that the addition of monoclonal antibodies against interleukin (IL)-4/IL-13 or dupilumab to the treatment is effective and allows the reduction in the dose of glucocorticoids in ABPA patients. However, there is no report of complete withdrawal of oral glucocorticoids after therapy with dupilumab in these patients. Here, we report the first case of ABPA in which complete withdrawal of oral glucocorticoid was possible after treatment with dupilumab.