Allergic bronchopulmonary aspergillosis successfully treated with mepolizumab: Case report and review of the literature

Abstract

A 56-year-old woman was referred to our hospital for recurrent asthma of 20 years duration. She was diagnosed as having allergic bronchopulmonary aspergillosis on the basis of clinical symptoms, peripheral blood eosinophilia, elevated total serum immunoglobulin E value, positive results of specific IgE and precipitating antibodies against Aspergillus sp., central bronchiectasis, and mucoid impaction. Systemic corticosteroids and anti-fungal therapy improved her symptoms, but the cessation of these treatments led to frequent exacerbations. Omalizumab improved her asthmatic symptoms to the point that corticosteroids could be stopped; however, radiological findings were not improved, and coexisting eosinophilic sinusitis and otitis media worsened. After her treatment was changed from omalizumab to mepolizumab, not only her asthmatic symptoms but also her sinusitis and otitis media became well controlled, and chest radiological findings improved.

Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review

“…In addition, 48% were receiving or had received antifungal therapy; 106 patients (69.7%) had baseline eosinophil counts >500 cells/µL. 10 , 12 , 13 , 16 – 33 55 patients (36%) had baseline IgE serum values >1000 IU/mL. 10 – 12 , 14 , 15 , 17 – 19 , 21 , 23 – 28 , 30 – 32 , 34 , 35 …”

“…Baseline FEV1 values were reported for eight studies (30 patients). 12 , 13 , 23 – 26 , 28 , 29 In seven studies 12 , 23 – 25 , 28 , 29 including 26 patients FEV 1 was reported in liters, with a median of 1.50 L (range 0.74–2.39). In the remaining study FEV1 was reported as the percentage predicted with a median of 52% (range 26–72).…”

“…Baseline IgE levels were reported for 12 patients, 12 , 13 , 23 – 28 with a median of 2145 IU/mL (range 134–8327 IU/ml). Four studies including four patients described post-treatment levels, with a median of 720 IU/mL (range 298–3400), reaching a reduction of 66.5% compared to baseline with a follow-up period between 5 and 14 months.…”

“…The use of systemic steroids was reported in eight studies, 12 , 13 , 24 – 29 including a total of 30 patients (93.7% of the population); three patients (10%) had a reduction to a dose between 2.5 and 5 mg/daily with follow-up periods ranging from 5 to 9 months 12 , 13 , 25 – 27 and the remaining 27 subjects (90%) had them suspended after 2–14 months of treatment. 13 , 24 , 26 , 28 , 29…”

“… 25 The remaining studies including a total of six patients (18.75% of the population) did not describe antifungal use post-treatment. 12 , 13 , 24 , 26 , 27 , 29…”