A case of allergic bronchopulmonary mycosis: 3D‐CT Findings led to successful multidisciplinary treatment with dupilumab and cryoprobe

Abstract

Abstract The present case involved a 78‐year‐old woman with repeated recurrences of allergic bronchopulmonary mycosis (ABPM) who presented to our outpatient clinic with a chief complaint of dyspnoea with respiratory failure. Computed tomography (CT) of the chest showed atelectasis of the lower lobes due to mucus plugs. Blood and biochemical tests showed a high peripheral blood eosinophil count (1330/μL) and elevated immunoglobulin E (15,041 IU/mL; normal, < 361 IU/mL). Recurrent ABPM was diagnosed. The patient also showed chronic lower respiratory tract infection associated with Mycobacterium avium complex and Pseudomonas aeruginosa. First, we removed the mucus plug with a cryoprobe to avoid administering corticosteroids. However, subsequent 3‐dimensional CT showed residual mucus plugs, so we administered dupilumab as an additional treatment. After initiating dupilumab, mucus plugs disappeared and respiratory failure resolved. We were able to implement multidisciplinary treatment that did not rely on corticosteroids.

Keywords

• 3D‐CT
• ABPM
• cryoprobe
• dupilumab
• mucus plug