Novel treatment of eosinophilic bronchitis with allergic fungal sinusitis using mepolizumab

Case Report This rare case report describes a patient with eosinophilic bronchitis with allergic fungal sinusitis treated with mepolizumab. A 29-year old man with a history of asthma complicated by eosinophilic sinusitis over 5 years was admitted to our hospital due to poor response to treatments, such as ICS/LABA/LAMA. The patient experienced a gradual worsening of asthma despite endoscopic sinus surgery which was conducted by the otolaryngology department. He was visiting the ER every two weeks, and was admitted to hospital once every month. Treatment response to asthma using methylprednisolone (PSL) 10mg/day and bronchial thermoplasty (BT) appeared to have a positive but temporary clinical effect. Prior to the third BT procedure, the patient was admitted to our hospital due to severe dyspnea. Blood eosinophil was 11.3% (WBC 94×100/μl, the number of blood eosinophils 1060.0/μl), and chest computed tomography (CT) showed ground-glass opacity (GGO) with centrilobular nodules. Bronchoscopy displayed the surface of the airway with remarkable rubefaction, and tortuous capillaries with engorgement. The percentage of eosinophil in bronchoalveolar lavage was 44%. The patient was subsequently diagnosed with eosinophilic bronchitis. The patient was administered a combination of PSL (40mg/day) and mepolizumab (100mg/month). Patients’ symptoms improved and post treatment CT revealed dissipation of GGO in both lungs. Tapering of PSL was completed after 2 months of treatment, and the patient has been symptom free for 8 months by novel treatment using mepolizumab.