用美泊利单抗和杜匹单抗联合生物疗法治疗严重嗜酸性粒细胞增多性多发性炎和慢性鼻窦炎伴鼻息肉。

IF 0.9 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Yonago acta medica Pub Date : 2024-04-17 eCollection Date: 2024-05-01 DOI:10.33160/yam.2024.05.005
Yosuke Nakamura, Naoki Kikumoto, Hiromi Takeuchi, Toru Kimura, Motoki Nakamori, Kazunori Fujiwara
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引用次数: 0

摘要

我们报告了一例 55 岁女性患者的病例,她患有嗜酸性粒细胞肉芽肿伴多血管炎和伴有鼻息肉的慢性鼻窦炎。鼻窦炎在全鼻腔内窥镜鼻窦手术后 6 个月复发。虽然采用了硫唑嘌呤和甲泼尼龙联合类固醇的常规治疗,但很难同时控制鼻炎和嗜酸性肉芽肿伴多血管炎。临床检查显示患者的嗅裂有息肉,而且患者的嗅觉障碍逐渐变得顽固。即使使用了一段时间的美泊珠单抗,症状也没有得到改善,但当生物制剂换成杜比鲁单抗后,顽固性慢性鼻窦炎伴鼻息肉的症状得到了改善。在对难治性慢性鼻炎伴鼻息肉患者间歇性使用杜必鲁单抗时,鼻炎得到了改善,但嗜酸性粒细胞肉芽肿伴多血管炎麻痹等症状也有所加重。这两种症状在开始间歇用药 19 个月后逐渐缓解,因此停用了杜比鲁单抗。嗜酸性粒细胞肉芽肿伴多血管炎引起的鼻窦炎在某些病例中可能是难治性的,本病例的研究结果表明了杜必鲁单抗对嗜酸性粒细胞炎症的强大疗效。
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Combination Biologic Therapy with Mepolizumab and Dupilumab for Severe Eosinophilic Granulomatosis with Polyangiitis and Chronic Rhinosinusitis with Nasal Polyp.

We report the case of a 55-year-old female with eosinophilic granulomatosis with polyangiitis and chronic rhinosinusitis with nasal polyp. Rhinosinusitis recurred 6 months after full-house endoscopic sinus surgery. Although conventional treatment with azathioprine and mepolizumab with steroids was given, it was difficult to simultaneously control both rhinosinusitis and eosinophilic granulomatosis with polyangiitis. Clinical examinations showed polyps in the olfactory cleft, and the patient's anosmia gradually became persistent. Even after administering mepolizumab for a certain period of time, symptoms did not improve, but when the biologic agent was switched to dupilumab, an improvement in recalcitrant chronic rhinosinusitis with nasal polyp was observed. While dupilumab was administered intermittently for refractory chronic rhinosinusitis with nasal polyp, the rhinosinusitis improved and symptoms such as worsening of eosinophilic granulomatosis with polyangiitis paresthesia were observed. Both symptoms gradually subsided 19 months after starting intermittent administration, leading to the discontinuation of dupilumab administration. Rhinosinusitis in the setting of eosinophilic granulomatosis with polyangiitis may be refractory in some cases, and this case provides findings demonstrating the strong effect of dupilumab on eosinophilic inflammation.

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来源期刊
Yonago acta medica
Yonago acta medica MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
1.60
自引率
0.00%
发文量
36
审稿时长
>12 weeks
期刊介绍: Yonago Acta Medica (YAM) is an electronic journal specializing in medical sciences, published by Tottori University Medical Press, 86 Nishi-cho, Yonago 683-8503, Japan. The subject areas cover the following: molecular/cell biology; biochemistry; basic medicine; clinical medicine; veterinary medicine; clinical nutrition and food sciences; medical engineering; nursing sciences; laboratory medicine; clinical psychology; medical education. Basically, contributors are limited to members of Tottori University and Tottori University Hospital. Researchers outside the above-mentioned university community may also submit papers on the recommendation of a professor, an associate professor, or a junior associate professor at this university community. Articles are classified into four categories: review articles, original articles, patient reports, and short communications.
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