A Case of Allergic Bronchopulmonary Aspergillosis With Failure of Benralizumab and Response to Dupilumab

Abstract

We report a case of a 68-year-old woman who was being treated for bronchial asthma and developed allergic bronchopulmonary aspergillosis (ABPA) that was unresponsive to benralizumab therapy but went into remission with dupilumab therapy. The patient presented with an exacerbation of dry cough and was diagnosed with ABPA based on new diagnostic criteria. Despite the attempted therapeutic intervention, the patient declined to use systemic corticosteroids due to concerns about potential side effects. Subsequently, itraconazole and benralizumab were administered, with temporary relief before relapse. Given the patient's refusal to continue itraconazole and benralizumab, dupilumab was administered as an alternative therapy, which resulted in significant improvement of both symptoms and imaging. Although the use of biological agents for ABPA lacks clear evidence, our results suggest that dupilumab may provide an effective therapeutic strategy.

Development of allergic bronchopulmonary aspergillosis in a patient with nontuberculous mycobacterial‐pulmonary disease successfully treated with dupilumab: A case report and literature review

“…Anti‐IL‐5/IL‐5 receptor antibodies are highly effective in patients with ABPA, especially for improving mucus plugging 25 . Previous case reports suggested that dupilumab is effective when switching from other biologics to this drug 26–30 . Similar to the present case, the therapeutic efficacy of dupilumab in patients with NTM‐PD 31 and the discontinuation of oral steroids during the use of dupilumab 32 were also observed in patients with ABPA.…”

“… 25 Previous case reports suggested that dupilumab is effective when switching from other biologics to this drug. 26 , 27 , 28 , 29 , 30 Similar to the present case, the therapeutic efficacy of dupilumab in patients with NTM‐PD 31 and the discontinuation of oral steroids during the use of dupilumab 32 were also observed in patients with ABPA. Of note, dupilumab treatment was associated with a reduced incidence of respiratory infections in patients with moderate‐to‐severe asthma or severe CRSwNP.…”

“…Biologics are not currently available for ABPM cases. Case reports and series have reported that the use of biologics targeting IgE, 24 IL‐5, 25 IL‐4/IL‐13, 26 , 27 , 28 , 29 , 30 , 31 , 32 and TSLP 33 improves the disease status of ABPA complicated by severe asthma. Monoclonal antibodies against IgE have therapeutic efficacy in patients with ABPA and severe asthma, including 12 of the 25 patients with NTM‐PD.…”

A case of allergic bronchopulmonary mycosis: 3D‐CT Findings led to successful multidisciplinary treatment with dupilumab and cryoprobe

“…NEW TREATMENT METHOD FOR ABPM reported cases of ABPM that responded to dupilumab, the mucus plugs were relatively small or located peripherally. 1,2 When a relatively large mucus plug located centrally results in atelectasis, as in the present case, treatment with dupilumab alone may take longer to improve clinical symptoms. The second reason was the need to focus on the mechanisms of mucus plug formation in ABPM and the fact that ABPM is caused by type I and type III hypersensitivity reactions to filamentous fungi.…”

“…Several case reports in recent years have described successful treatment of allergic bronchopulmonary mycosis (ABPM) with dupilumab, 1 , 2 but none have reported multidisciplinary treatment with dupilumab and a cryoprobe after visualizing mucus plugs obstructing the entire bronchus using 3‐dimensional (3D) computed tomography (CT).…”