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(A, B) Chest computed tomography (CT) at the first visit. High-attenuation mucus plugs were found mainly in the right upper bronchus on chest CT. (C) Histological finding of mucus plug (red arrow: Charcot Leyden crystal). (D) Chest CT scan 6 months after starting dupilumab
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Hounsfield unit) in some bronchi (Figure 1A, B). He was suspected to have allergic bronchopulmonary aspergillosis (ABPA) and was referred to our department for further investigations. Histological examination of mucus plugs obtained by bronchoscopy revealed many eosinophils and Charcot Leyden crystals (Figure 1C); however, no fungi were found both pathologically and in culture. Moreover, chest CT scan showed the disappearance of most mucus plugs and mucus plug score decreased from 9 to 3 (Figure 1D).