Journal
RESPIROLOGY CASE REPORTS
Volume 9, Issue 8, Pages -Publisher
WILEY
DOI: 10.1002/rcr2.805
Keywords
Adalimumab; allergic bronchopulmonary aspergillosis; ankylosing spondylitis; anti-tumour necrosis factor-alpha antibody
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A case of ABPA occurred in a man treated with adalimumab for AS, showing improvement after withdrawal of adalimumab treatment. This suggests a possible causal relationship between anti-TNF-alpha antibodies and ABPA.
We herein report a case of allergic bronchopulmonary aspergillosis (ABPA) that occurred in a man treated with adalimumab for ankylosing spondylitis (AS). A 69-year-old man with a history of ankylosing spondylitis treated by adalimumab, an anti-tumour necrosis factor-alpha (TNF-alpha) antibody, developed cough and wheezing. Chest computed tomography showed obstruction of dilated left upper lobe bronchus by high attenuation mucus as well as central bronchiectasis. Both Aspergillus-specific immunoglobulin E (IgE) and Aspergillus precipitating antibody were positive and Aspergillus fumigatus was detected in a sputum culture. According to the new diagnostic criteria, the patient was diagnosed with ABPA. His condition rapidly improved after the withdrawal of adalimumab and initiation of prednisolone and itraconazole. Anti-TNF-alpha antibody might cause ABPA through both aggravation of the host's T-helper 2 immunological response and anti-fungal response.
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