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

• Case report
• Open Access
• 
  

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

Allergy, Asthma & Clinical Immunology volume 18, Article number: 35 (2022) 

• details

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.

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