Top

Published in:

Open Access 01-12-2022 | Expectoration | Case report

Refractory flare-up of severe bronchial asthma controlled with mepolizumab due to Pneumocystis pneumonia: a case report

Authors: Kazuya Takeda, Toshiyuki Sumi, Yuta Nagahisa, Keigo Matsuura, Motoki Sekikawa, Hiroki Watanabe, Yuichi Yamada, Hirofumi Chiba

Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2022

Abstract

Background

Biologics dramatically improve symptoms of severe asthma; however, various exacerbating factors may induce flare-up. Pneumocystis spp. have not been reported as a cause of asthma exacerbation during biologic use, although patients with severe asthma have high levels of antibodies against Pneumocystis spp.

Case presentation

An 87-year-old female with severe asthma that was well-controlled with mepolizumab, who developed a steroid-resistant refractory flare-up. Chest computed tomography showed bilateral ground glass opacities, and results of polymerase chain reaction tests on induced sputum were positive for Pneumocystis DNA. Therefore, a diagnosis of Pneumocystis pneumonia was made. The clinical symptoms improved after treatment with sulfamethoxazole–trimethoprim.

Conclusion

Clinicians should be aware of Pneumocystis pneumonia as a cause of refractory exacerbation of bronchial asthma during use of interleukin-5 inhibitors.

McGregor MC, Krings JG, Nair P, Castro M. Role of biologics in asthma. Am J Respir Crit Care Med. 2019;199(4):433–45. https://doi.org/10.1164/rccm.201810-1944CI.CrossRefPubMedPubMedCentral

Trevor J, Lugogo N, Carr W, Moore WC, Soong W, Panettieri RA Jr, Desai P, Trudo F, Ambrose CS. Severe asthma exacerbations in the United States: incidence, characteristics, predictors, and effects of biologic treatments. Ann Allergy Asthma Immunol. 2021;127(5):579-587.e1. https://doi.org/10.1016/j.anai.2021.07.010.CrossRefPubMed

Matsumoto-Sasaki M, Shimizu K, Suzuki M, Suzuki M, Nakamaru Y, Konno S. A case of severe asthma switched to mepolizumab due to late-occurring unresponsiveness to Benralizumab. Arerugi. 2020;69(8):678–82. https://doi.org/10.15036/arerugi.69.678.CrossRefPubMed

Eddens T, Kolls JK. Pathological and protective immunity to Pneumocystis infection. Semin Immunopathol. 2015;37(2):153–62. https://doi.org/10.1007/s00281-014-0459-z.CrossRefPubMed

Takeuchi T, Tatsuki Y, Nogami Y, Ishiguro N, Tanaka Y, Yamanaka H, Kamatani N, Harigai M, Ryu J, Inoue K, Kondo H, Inokuma S, Ochi T, Koike T. Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis. 2008;67(2):189–94. https://doi.org/10.1136/ard.2007.072967.CrossRefPubMed

Rayens E, Noble B, Vicencio A, Goldman DL, Bunyavanich S, Norris KA. Relationship of Pneumocystis antibody responses to paediatric asthma severity. BMJ Open Respir Res. 2021;8(1): e000842. https://doi.org/10.1136/bmjresp-2020-000842.CrossRefPubMedPubMedCentral

Eddens T, Campfield BT, Serody K, Manni ML, Horne W, Elsegeiny W, McHugh KJ, Pociask D, Chen K, Zheng M, Alcorn JF, Wenzel S, Kolls JK. A novel CD4⁺ T cell-dependent murine model of pneumocystis-driven asthma-like pathology. Am J Respir Crit Care Med. 2016;194(7):807–20. https://doi.org/10.1164/rccm.201511-2205OC.CrossRefPubMedPubMedCentral

Reid AB, Chen SC, Worth LJ. Pneumocystis jirovecii pneumonia in non-HIV-infected patients: new risks and diagnostic tools. Curr Opin Infect Dis. 2011;24(6):534–44. https://doi.org/10.1097/QCO.0b013e32834cac17.CrossRefPubMed

Swain SD, Meissner NN, Siemsen DW, McInnerney K, Harmsen AG. Pneumocystis elicits a STAT6-dependent, strain-specific innate immune response and airway hyperresponsiveness. Am J Respir Cell Mol Biol. 2012;46(3):290–8. https://doi.org/10.1165/rcmb.2011-0154OC (Epub 2011 Sep 29).CrossRefPubMedPubMedCentral

10.

Kelly MN, Shellito JE. Current understanding of Pneumocystis immunology. Future Microbiol. 2010;5(1):43–65. https://doi.org/10.2217/fmb.09.116.CrossRefPubMed

11.

Vera C, Rueda ZV. Transmission and colonization of Pneumocystis jirovecii. J Fungi (Basel). 2021;7(11):979. https://doi.org/10.3390/jof7110979.CrossRef

12.

Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996;71(1):5–13. https://doi.org/10.4065/71.1.5.CrossRefPubMed

13.

Baden LR, Swaminathan S, Angarone M, Blouin G, Camins BC, Casper C, Cooper B, Dubberke ER, Engemann AM, Freifeld AG, Greene JN, Ito JI, Kaul DR, Lustberg ME, Montoya JG, Rolston K, Satyanarayana G, Segal B, Seo SK, Shoham S, Taplitz R, Topal J, Wilson JW, Hoffmann KG, Smith C. Prevention and treatment of cancer-related infections, version 2 2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(7):882–913. https://doi.org/10.6004/jnccn.2016.0093.CrossRefPubMed

14.

Cho SJ, Stout-Delgado HW. Aging and lung disease. Annu Rev Physiol. 2020;10(82):433–59.CrossRef

15.

Price D, Castro M, Bourdin A, Fucile S, Altman P. Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety. Eur Respir Rev. 2020;29(155): 190151.CrossRef

16.

Price DB, Trudo F, Voorham J, Xu X, Kerkhof M, Ling Zhi Jie J, Tran TN. Adverse outcomes from initiation of systemic corticosteroids for asthma long-term observational study. J Asthma Allergy. 2018;11:193–204.CrossRef

17.

Ravin KA, Loy M. The eosinophil in infection. Clin Rev Allergy Immunol. 2016;50(2):214–27. https://doi.org/10.1007/s12016-015-8525-4.CrossRefPubMed

18.

Eddens T, Elsegeiny W, Nelson MP, Horne W, Campfield BT, Steele C, Kolls JK. Eosinophils contribute to early clearance of Pneumocystis murina infection. J Immunol. 2015;195(1):185–93. https://doi.org/10.4049/jimmunol.1403162.CrossRefPubMed

Title: Refractory flare-up of severe bronchial asthma controlled with mepolizumab due to Pneumocystis pneumonia: a case report
Authors: Kazuya Takeda
Toshiyuki Sumi
Yuta Nagahisa
Keigo Matsuura
Motoki Sekikawa
Hiroki Watanabe
Yuichi Yamada
Hirofumi Chiba
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Expectoration
Bronchial Asthma
Mepolizumab
Human Immunodeficiency Virus
Pneumonia
Prednisolone
Published in: Allergy, Asthma & Clinical Immunology / Issue 1/2022
Electronic ISSN: 1710-1492
DOI: https://doi.org/10.1186/s13223-022-00678-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Refractory flare-up of severe bronchial asthma controlled with mepolizumab due to Pneumocystis pneumonia: a case report

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Effectiveness and safety of allergen immunotherapy in patients with allergic rhinitis complicated by rheumatic autoimmune diseases: a case series study

Understanding attitudes and obstacles to vaccination against COVID-19 in patients with primary immunodeficiency

Hypereosinophilic syndrome presenting as coagulopathy

Long-term prophylaxis with lanadelumab for HAE: authorization for temporary use in France

Improvement of peripheral neuropathy in a patient with antineutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis by additional mepolizumab

miR-3934 regulates the apoptosis and secretion of inflammatory cytokines of basophils via targeting RAGE in asthma