Allergic Bronchopulmonary Aspergillosis with Atelectasis Controlled by Omalizumab

Abstract

Background. Allergic bronchopulmonary aspergillosis (ABPA) is characterized by asthmatic symptoms and sometimes causes atelectasis by mucus plugs. This disease is treated by oral corticosteroid, but its activity is often uncontrollable. Case. A 70-year-old woman treated as an asthmatic patient was hospitalized due to an asthmatic attack and right lower lobe atelectasis with eosinophilia when she was 64 years old. Both the serum total and Aspergillus fumigatus (AF)-specific immunoglobulin E levels were high, and AF precipitins were positive. Bronchoscopic findings showed a mucus plug in the right basal bronchus. Finally, ABPA was diagnosed treatment by oral corticosteroid was begun, however the atelectasis often recurred. We started omalizumab 300 mg every other week for her. Atelectasis had not recurred after 11 months from the initiation of omalizumab therapy, and 34 months later, the steroid and oxygen therapy were discontinued. Moreover the disease activity has been kept under control since then. Conclusion. We speculated that omalizumab could be useful for treatment of uncontrollable formation of mucus plug in ABPA.