度普利尤单抗治疗变应性支气管肺曲霉病后糖皮质激素完全撤减：一例报告
Complete withdrawal of glucocorticoids after dupilumab therapy in allergic bronchopulmonary aspergillosis: A case report.
作者信息
Nishimura Tadashi, Okano Tomohito, Naito Masahiro, Tsuji Chikashi, Iwanaka Soichi, Sakakura Yasumasa, Yasuma Taro, Fujimoto Hajime, D'Alessandro-Gabazza Corina N, Oomoto Yasuhiro, Kobayashi Tetsu, Gabazza Esteban C, Ibata Hidenori
机构信息
Department of Pulmonary Medicine, Mie Chuo Medical Center, Tsu 514-1101, Mie, Japan.
Department of Pulmonary and Critical Care Medicine, Mie University, Tsu 514-8507, Mie, Japan.
出版信息
World J Clin Cases. 2021 Aug 16;9(23):6922-6928. doi: 10.12998/wjcc.v9.i23.6922.
BACKGROUND
Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to 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 . 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.
背景
变应性支气管肺曲霉病（ABPA）是对加重支气管哮喘的曲霉属物种的一种过敏反应。既往研究显示度普利尤单抗对ABPA患者有糖皮质激素节省效应。尚无度普利尤单抗治疗后完全停用糖皮质激素的报道。
病例摘要
该患者为一名54岁女性，患有支气管哮喘，接受吸入性糖皮质激素和长效β2受体激动剂治疗。2017年3月，她因咳痰和发热前来我院就诊。胸部计算机断层扫描显示黏液嵌塞，支气管灌洗液培养曲霉菌阳性。诊断为ABPA。该患者于2017年4月至2017年11月接受口服糖皮质激素治疗。2019年1月，她出现支气管哮喘加重，胸部计算机断层扫描显示复发性黏液嵌塞。她接受了口服糖皮质激素和伊曲康唑治疗。2020年2月，在口服糖皮质激素减量期间，她出现第三次支气管哮喘加重和黏液嵌塞。除口服糖皮质激素和伊曲康唑外，该患者还接受了度普利尤单抗治疗。临床反应改善，2020年6月停用口服糖皮质激素。
结论
这是首例经度普利尤单抗治疗后可完全停用糖皮质激素的ABPA病例。
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