Concomitant allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangiitis after Aspergillus niger infection

Coutinho, Inês; Lopes, Mariana Canuto Melo de Sousa; LIMA, FERNANDO CASTRO PESSOA DE; Ventura, Conceição; Rabadão, Eduardo; Alfaro, Tiago M.; Cunha, José Saraiva da; Regateiro, Frederico S.

doi:10.1016/j.pulmoe.2021.12.004

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Eight cases of coexisting EGPA and ABPA were included in this paper, bringing the total number of cases reviewed to nine (Table 1). Instances of concurrent EGPA and ABPA have been reported in the literature [10][11][12][13][14][15]. EGPA may precede or follow ABPA, and they can be diagnosed concurrently.…”

Section: Discussionmentioning

confidence: 99%

“…Some diagnostic criteria are common, and differential diagnosis is recommended. Several reports described the sequential occurrence of ABPA and EGPA, or vice versa [10][11][12][13][14][15]. How one established disease may predispose to the other is unknown, but it may include eosinophil recruitment by T helper 2 (Th2)-driven inflammation predisposing to fungal colonization and subsequent hypersensitivity [15].…”

Section: Discussionmentioning

confidence: 99%

“…Instances of concurrent EGPA and ABPA have been reported in the literature [ 10 - 15 ]. EGPA may precede or follow ABPA, and they can be diagnosed concurrently.…”

Section: Discussionmentioning

confidence: 99%

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Coexistence of Eosinophilic Granulomatosis With Polyangiitis and Allergic Bronchopulmonary Aspergillosis: A Fascinating Relationship

Marra,

Curci,

Franco

et al. 2024

Cureus

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Elevated eosinophil counts are associated with various diseases, including eosinophilic granulomatosis with polyangiitis (EGPA) and allergic bronchopulmonary aspergillosis (ABPA). EGPA is a rare small-vessel vasculitis characterized by asthma, eosinophilia, fleeting pulmonary infiltrates, and systemic manifestations. ABPA, initiated by immune reactions against Aspergillus fumigatus in the airways, presents with poorly controlled asthma, wheezing, hemoptysis, productive cough, and systemic symptoms, which result in characteristic central bronchiectasis. Fleeting pulmonary opacities are common radiologic findings. We present a case of ABPA in a patient with a prior EGPA diagnosis under treatment with mepolizumab 300 mg monthly and review eight similar cases from the literature. In these cases, EGPA and ABPA diagnoses preceded each other or were concurrent. Treatment of the latter improved control of both diseases. IL-5 is pivotal in EGPA pathogenesis, and mepolizumab, targeting IL-5, has been effective in EGPA treatment. Our patient received mepolizumab for EGPA and continued it post-ABPA diagnosis, showing favorable outcomes. This suggests mepolizumab as a therapeutic link between EGPA and ABPA. Mepolizumab therapy holds promise for managing both EGPA and ABPA. Double-blind placebo-controlled studies are warranted to establish its efficacy and safety for ABPA, emphasizing the need for further research in this area.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Coexistence of Eosinophilic Granulomatosis With Polyangiitis and Allergic Bronchopulmonary Aspergillosis: A Fascinating Relationship

Marra,

Curci,

Franco

et al. 2024

Cureus

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Amphotericin-b-liposomal/voriconazole

2022

Reactions Weekly

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Eosinophilic granulomatosis with polyangiitis – Advances in pathogenesis, diagnosis, and treatment

Fijołek¹,

Radzikowska²

2023

Front. Med.

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease characterized by eosinophil-rich granulomatous inflammation and necrotizing vasculitis, pre-dominantly affecting small-to-medium-sized vessels. It is categorized as a primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) but also shares features of hypereosinophilic syndrome (HES); therefore, both vessel inflammation and eosinophilic infiltration are suggested to cause organ damage. This dual nature of the disease causes variable clinical presentation. As a result, careful differentiation from mimicking conditions is needed, especially from HES, given the overlapping clinical, radiologic, and histologic features, and biomarker profile. EGPA also remains a diagnostic challenge, in part because of asthma, which may pre-dominate for years, and often requires chronic corticosteroids (CS), which can mask other disease features. The pathogenesis is still not fully understood, however, the interaction between eosinophils and lymphocytes B and T seems to play an important role. Furthermore, the role of ANCA is not clear, and only up to 40% of patients are ANCA-positive. Moreover, two ANCA-dependent clinically and genetically distinct subgroups have been identified. However, a gold standard test for establishing a diagnosis is not available. In practice, the disease is mainly diagnosed based on the clinical symptoms and results of non-invasive tests. The unmet needs include uniform diagnostic criteria and biomarkers to help distinguish EGPA from HESs. Despite its rarity, notable progress has been made in understanding the disease and in its management. A better understanding of the pathophysiology has provided new insights into the pathogenesis and therapeutic targets, which are reflected in novel biological agents. However, there remains an ongoing reliance on corticosteroid therapy. Therefore, there is a significant need for more effective and better-tolerated steroid-sparing treatment schemes.

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Concomitant allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangiitis after Aspergillus niger infection

Cited by 4 publications

References 7 publications

Coexistence of Eosinophilic Granulomatosis With Polyangiitis and Allergic Bronchopulmonary Aspergillosis: A Fascinating Relationship

Coexistence of Eosinophilic Granulomatosis With Polyangiitis and Allergic Bronchopulmonary Aspergillosis: A Fascinating Relationship

Amphotericin-b-liposomal/voriconazole

Eosinophilic granulomatosis with polyangiitis – Advances in pathogenesis, diagnosis, and treatment

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