Open AccessAllergic bronchopulmonary aspergillosis presumably unmasked by PD-1 inhibition
Author(s) -
Anthony A. Donato,
Ronald Krol
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-227814
Subject(s) - medicine , eosinophilia , pembrolizumab , allergic bronchopulmonary aspergillosis , aspergillus fumigatus , immunology , aspergillosis , hypersensitivity pneumonitis , bronchiectasis , eosinophil , pneumonitis , asthma , allergy , immunoglobulin e , gastroenterology , immune system , immunotherapy , lung , antibody
Programmed cell death-1 (PD-1) inhibitors stimulate immune recognition of tumour cells in cancer patients, but have significant autoimmune side effects including pneumonitis. We report the case of a patient with asthma and mild eosinophilia who developed unusual pulmonary side effect of bronchiectasis, severe eosinophilia (absolute eosinophil count: 3200 c/mm 3 ) and elevated IgE levels (7050 IU/mL; normal: <164 IU/mL) 4 months into therapy with the PD-1 inhibitor pembrolizumab. Aspergillus fumigatus IgG was elevated at 15.60 U/mL (normal: <12.01 U/mL). He responded to therapy with corticosteroids and voriconazole and was able to resume pembrolizumab thereafter with good clinical response.