PMC6558237_01
Chest CT at the diagnosis of ABPA and 6 months after the start of the systemic corticosteroid and itraconazole. A: Chest CT at the diagnosis of ABPA (at admission) in the patient, a 60-year-old Japanese female. The chest CT shows the bilateral infiltrative shadows (arrow) and central bronchiectasis with mucous plugs (arrowheads). B: Chest CT at 6 months after treatment. The chest CT shows the disappearance of the bilateral infiltrative shadows and mucous plugs.
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High-resolution computed tomography (HRCT) of the chest revealed bilateral infiltrative shadows and central bronchiectasis with mucous plugs (Fig. 1). Then her symptoms improved and the bilateral infiltrative shadows and mucous plugging had disappeared at 6 months after the start of this treatment (Fig. 1).
Bronchoscopy findings at the diagnosis of ABPA. Mucous plugs filled the anterior basal segmental bronchus of the left lung.
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Bronchoscopy showed mucous plugs in the anterior basal segmental bronchus of the left lung (Fig. 2).
Chest CT at 4 months before and 5 months after the mepolizumab treatment. A: Chest CT at 4 months before the administration of mepolizumab. The chest CT shows mucous plugs in the posterior basal segment bronchus of the right lung (arrowhead) and the anterior basal segment bronchus of the left lung and small nodular shadows in the anterior basal segment of the right lower lobe (arrow). B: Chest CT at 5 months after the mepolizumab treatment. The chest CT shows the disappearance of mucous plugs (arrowhead) and no change in the small nodular shadows in the anterior basal segment of the right lower lobe (arrow). The bilateral infiltrative shadows and central bronchiectasis with mucous plug. B: Chest CT at 6 months after treatment, showing the disappearance of bilateral infiltrative shadows and mucous plugs.
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April 2018, the patient reported often re-experiencing asthma attacks and dyspnea on exertion, despite increasing of the dose of prednisolone. A chest CT examination revealed new mucous plugs in the posterior basal segment bronchus of the right lung and the anterior basal segment bronchus of the left lung and small nodular shadows in the anterior basal segment of the right lower lobe (Fig. 3A). At the final visit, 5 months after starting mepolizumab, the patient was free from respiratory symptoms, the mucous plugs had disappeared and the small nodular shadows were comparable with the CT findings of 5 months before (Fig. 3B).
The patient's clinical course, before and after mepolizumab treatment. Changes in the patient's blood eosinophil count, serum IgE level, dose of oral prednisolone and inhalation of budesonide/formoterol (BUD/FM), forced expiratory volume in one second (FEV1), forced expiratory volume % in one second (FEV1%), and fractional exhaled nitric oxide (FeNO) level. After the mepolizumab treatment (100 mg/4 weeks), the blood eosinophil count dropped from 276/muL to 20/muL, the serum IgE level dropped from 4,970 IU/L to 2157 IU/L, and the FeNO level dropped from 67 ppb to 39 ppb.
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The daily doses of prednisolone and BUD/FM were also reduced without the exacerbation of asthma symptoms (Fig. 4).