title: Allergic bronchopulmonary aspergillosis in a patient with rheumatoid arthritis under adalimumab therapy: a case report.
abstract: A 77-year-old woman with a 15-year history of rheumatoid arthritis (RA) was admitted to our hospital because of a wet cough that persisted for 1 month. The patient had been taking methotrexate (MTX) and adalimumab (ADA) for the past 3 years, and disease activity of RA was low. Discontinuation of ADA and MTX and treatment with oral levofloxacin were not effective. On admission, laboratory examinations showed eosinophilia (2539/μL), elevated serum total immunoglobulin E (538.0 IU/ml) and Aspergillus-specific immunoglobulin E levels, and Aspergillus fumigatus serum precipitins. A chest radiograph revealed multiple bilateral pulmonary shadows, and computed tomography revealed multiple consolidations. Bronchoscopic examination showed mucous plugs. Pathological examination revealed diffuse infiltration of eosinophils and fungus in the plugs. These findings led to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). A combination of prednisolone (0.5 mg/kg/day) and itraconazole (200 mg/day) was administered. After 3 months, the pulmonary consolidations resolved. To our knowledge, this is the first report of ABPA in a patient with RA treated with ADA. If patients treated with biologic disease-modifying antirheumatic drugs present with eosinophilia and pulmonary consolidations, clinicians should consider ABPA in the differential diagnosis.
authors.affiliation: Department of Rheumatology, Tokyo Kyosai Hospital.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Mari
authors.initials: M
authors.lastname: Kamiya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Jun
authors.initials: J
authors.lastname: Takagiwa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nonomura
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D018501:Antirheumatic Agents; D017964:Itraconazole; D011239:Prednisolone; D000068879:Adalimumab