Eosinophilic chronic rhinosinusitis accompanied by asthma with dissimilar upper and lower airway responsiveness to mepolizumab and dupilumab: A case report

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  • Hosoya Kei
    Department of Otolaryngology, Nippon Medical School, Tama Nagayama Hospital
  • Komachi Taro
    Department of Otolaryngology, Nippon Medical School, Chiba Hokusoh Hospital
  • Hirose Takashi
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital
  • Sato Kazuki
    Department of Otolaryngology, Nippon Medical School, Tama Nagayama Hospital
  • Okubo Kimihiro
    Department of Otolaryngology, Head and Neck Surgery, Nippon Medical School Hospital

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  • Mepolizumabとdupilumabとで上下気道の反応性が異なった喘息合併好酸球性副鼻腔炎の1例

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<p>Eosinophilic chronic rhinosinusitis (ECRS) is often associated with asthma and serves as a risk factor for frequent asthma exacerbation. Recent studies have reported the usefulness of biologics for management of ECRS and asthma in patients who are unresponsive to oral steroids.</p><p>A man in his 70s was diagnosed with aspirin-induced asthma and chronic obstructive pulmonary disease approximately 5 years prior to presentation. Mepolizumab therapy was initiated owing to unresponsiveness to treatment including oral steroid administration. Asthma attacks reduced in frequency; however, oral steroids could not be withdrawn. The patient developed nasal symptoms following a 28-month course of mepolizumab therapy, which was therefore switched to dupilumab to improve sinusitis and asthma. The patient was diagnosed with severe ECRS based on a Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis score of 15, asthma, and biopsy proven evidence of nasal polyps. Nasal symptoms, except for olfactory dysfunction and sinusitis improved following 7-month dupilumab treatment; however, lung dysfunction and asthma persisted.</p><p>Close interdisciplinary collaboration between Respiratory Medicine and Otorhinolaryngology is essential for accurate evaluation and treatment of patients with dissimilar responsiveness of the upper and lower respiratory tracts to treatment with the aforementioned medications.</p>

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