PMC7193122_01
Findings of chest images and pathology on first admission.. (A) Chest X-ray showed infiltrative shadows in the bilateral upper lung fields.. (B) Chest computed tomography (CT) showed consolidation and ground-glass opacity (GGO) in bilateral upper lobes.. (C) Bronchial cryobiopsy through fiberoptic bronchoscopy was performed in right B3a.. (D) Pathological specimen of cryobiopsy showed increased eosinophil infiltration in the alveolar space.
gr1.jpg
PMC7193122_01_gr1.jpg
fig1
C-reactive protein level was slightly elevated (3.04 mg/dL) and chest X-ray showed infiltrative shadows in the upper lung fields bilaterally (Fig. 1A). Chest computed tomography (CT) showed consolidation and ground-glass opacity (GGO) in bilateral upper lobes (Fig. 1B). The pathological examination of bronchial cryobiopsy specimens obtained from the right B3a (Fig. 1C) showed high levels of eosinophil infiltration in the alveolar space (Fig. 1D).
Treatment and clinical course. The patient responded to prednisolone, and her peripheral blood eosinophil counts decreased. Peripheral eosinophil counts increased after prednisolone termination. After a single dose of benralizumab, her symptoms disappeared and the peripheral eosinophil count was zero.
gr2.jpg
PMC7193122_01_gr2.jpg
fig2
She responded to the treatment and her symptoms disappeared with a decrease in peripheral blood eosinophil counts (Fig. 2), along with an amelioration of abnormal shadows on chest X-ray. However, her symptoms worsened after prednisolone termination, and her peripheral eosinophil counts rebounded (Fig. 2).
Findings of chest images after a single dose of benralizumab for relapsed chronic eosinophilic pneumonia (CEP).. (A) Chest X-ray showed a relapse of infiltrative shadows in the right upper lung field.. (B) Abnormal infiltrates in the right upper lung field on chest X-ray showed ameliorations 1 week after administration of benralizumab.. (C) Abnormal infiltrates in the right upper lung field on chest X-ray continued to show marked ameliorations 2 weeks after administration of benralizumab.. (D) Chest X-ray shadow continued to be markedly ameliorated 1 month afterward.. (E) Chest CT showed only slight ground-glass opacity (GGO) 1 month after benralizumab administration.. (F) Chest X-ray showed no abnormal shadows at almost 6 months after benralizumab administration.
gr3.jpg
PMC7193122_01_gr3.jpg
fig3
Fresh abnormal infiltrative shadows appeared in the right upper lung field (Fig. 3A). Abnormal infiltrates in the right upper lung field also ameliorated on chest X-ray (Fig. 3B). Abnormal infiltrates in the right upper lung field were markedly ameliorated on chest X-ray 2 weeks after benralizumab administration (Fig. 3C). Marked ameliorations in the abnormal findings on chest X-ray and CT were sustained even 1 month afterward (Fig. 3D and E). At the time of drafting of the case report almost 6 months after benralizumab administration, the patient has not shown CEP relapse and remains asymptomatic (Fig. 3F).