Development of allergic bronchopulmonary aspergillosis in a patient with nontuberculous mycobacterial‐pulmonary disease successfully treated with dupilumab: A case report and literature review

Abstract

Abstract Pulmonary manifestations in patients with allergic bronchopulmonary aspergillosis (ABPA) and nontuberculous mycobacterial‐pulmonary disease (NTM‐PD) include bronchiectasis and mucus plugging. A 68‐year‐old woman, treated with antibiotics and inhaled corticosteroids for NTM‐PD and asthma, presented with fever and wheezing. ABPA was diagnosed based on laboratory findings (elevated peripheral blood eosinophil counts and serum total IgE levels and positive Aspergillus‐specific IgE and IgG) and imaging observation of a high‐attenuation mucus plug. Systemic prednisolone was avoided to prevent NTM‐PD progression. Dupilumab, a monoclonal antibody that blocks IL‐4/13, was introduced to improve the clinical findings. Herein, we discuss the pathophysiological mechanisms underlying this rare comorbidity.

Keywords

• allergic bronchopulmonary aspergillosis
• bronchiectasis
• dupilumab
• mucus plug
• nontuberculous mycobacterial‐pulmonary disease