Allergic bronchopulmonary aspergillosis in a lung transplant recipient treated with mepolizumab

Foteini Ioakeim; Christophe Abellan; Alessio Casutt; Benoit Lechartier; Leslie Noirez; Catherine Beigelman-Aubry; John-David Aubert; Zisis Balmpouzis; Angela Koutsokera

doi:10.1016/j.clim.2024.110265

Allergic bronchopulmonary aspergillosis in a lung transplant recipient treated with mepolizumab

Clin Immunol. 2024 Jul:264:110265. doi: 10.1016/j.clim.2024.110265. Epub 2024 May 25.

Authors

Foteini Ioakeim¹, Christophe Abellan², Alessio Casutt³, Benoit Lechartier⁴, Leslie Noirez⁴, Catherine Beigelman-Aubry⁵, John-David Aubert⁴, Zisis Balmpouzis⁶, Angela Koutsokera⁶

Affiliations

¹ Lung Transplant Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: [email protected].
² Lung Transplant Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Internal Medicine service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
³ Lung Transplant Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Division of Pulmonology, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Lugano, Switzerland.
⁴ Lung Transplant Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁵ Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
⁶ Lung Transplant Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Adult Cystic Fibrosis and CFTR-related disorders Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, University of Lausanne, Switzerland.

PMID: 38801928
DOI: 10.1016/j.clim.2024.110265

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus spp. ABPA diagnosis may be challenging due to its non-specific presentation. Standard ABPA treatment consists of systemic corticosteroids and antifungal agents. Mepolizumab, a monoclonal antibody against interleukin-5 seems to be a promising treatment for ABPA. Data about ABPA following lung transplantation (LuTx) are scarce. LuTx recipients are at higher risk for adverse effects of ABPA treatment compared to the general population. Here we present a case of a LuTx recipient who was successfully treated with mepolizumab for ABPA following LuTx. Prolonged administration of high dose prednisone was thus avoided. To our knowledge, this is the first case describing mepolizumab administration following LuTx. Mepolizumab seems particularly attractive as a corticosteroid-sparing agent or as an alternative option to antifungal treatments, because of its excellent safety profile and low risk of drug interactions.

Keywords: Allergic bronchopulmonary aspergillosis; Allergic bronchopulmonary mycosis; Anti-interleukin-5; Lung transplant; Mepolizumab.

Publication types

Case Reports

MeSH terms

Antibodies, Monoclonal, Humanized* / adverse effects
Antibodies, Monoclonal, Humanized* / therapeutic use
Antifungal Agents / therapeutic use
Aspergillosis, Allergic Bronchopulmonary* / drug therapy
Humans
Lung Transplantation* / adverse effects
Middle Aged

Substances

Antibodies, Monoclonal, Humanized
Antifungal Agents
mepolizumab