Severe asthma concomitant with allergic bronchopulmonary aspergillosis (ABPA) and non-steroid exacerbated respiratory disease (N-ERD) successfully treated with mepolizumab: A case report.

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease characterized by a hypersensitivity reaction to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis is characterized by increased serum IgE levels, peripheral blood eosinophilia and radiographic pulmonary infiltrates, central bronchiectasis, and mucus plugs. Mepolizumab, a monoclonal interleukin (IL)-5 antibody, reduces eosinophilic inflammation and improves symptom control in severe eosinophilic asthma. A 74-year-old male patient arrived at our allergy outpatient clinic complaining of shortness of breath and cough. He had a history of asthma, NSAIDs Exacerbated Respiratory Disease (N-ERD) and endoscopic sinus surgery (ESS) due to chronic sinusitis with nasal polyps (CRSwNPs). At the time of admission to our clinic, his asthma control test (ACT) score was 5. The laboratory test results= eosinophil count (cells/mcL)= 570, total IgE= 3976 IU/mL, Aspergillus-specific IgE= 1.87 kIU/L (>0.35 positive). In the pulmonary function tests, forced expiratory volume in 1s (FEV1) was 28%. Thoracic computed tomography of the patient revealed central cystic bronchiectatic areas and mucus plugs. The patient was diagnosed with ABPA. The case reported here is of a patient diagnosed with severe asthma concomitant with ABPA and N-ERD, who was successfully treated with mepolizumab. Randomized double-blind placebo-controlled studies are needed to evaluate the efficacy of mepolizumab treatment in these patients.