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Allergic Bronchopulmonary Mycosis Caused by Schizophyllum commune Successfully Treated With Mepolizumab

Summary

A 70-year-old man developed a serious lung condition caused by a fungal infection (Schizophyllum commune) that resulted in dangerous mucus buildup and asthma attacks despite standard treatments. When traditional medications failed, doctors tried a newer biologic drug called mepolizumab that targets immune cells causing inflammation. The treatment successfully cleared the mucus, improved breathing, and allowed the patient to stop taking steroid medications while remaining symptom-free for over two years.

Background

Allergic bronchopulmonary mycosis (ABPM) is a serious complication of bronchial asthma that can lead to lung damage and respiratory failure. Standard treatment with systemic steroids increases risks of infections, osteoporosis, and other complications. Alternative therapeutic approaches include mucus plug removal by bronchoscopy, antifungal agents, and immunomodulatory biologics.

Objective

This case report describes the successful treatment of ABPM caused by Schizophyllum commune in a patient with refractory bronchial asthma who was unresponsive to corticosteroid and antifungal therapy. The objective was to demonstrate that mepolizumab, an anti-IL-5 monoclonal antibody, could effectively treat this condition.

Results

Mepolizumab treatment successfully cleared mucus plugs, decreased eosinophil counts, reduced IgE levels, and improved wheezing and desaturation. The patient’s Asthma Control Test score increased from 8 to 21. Prednisolone was gradually tapered and discontinued without recurrence over a 2-year follow-up period.

Conclusion

Mepolizumab effectively treated ABPM caused by S. commune in a patient with severe refractory asthma who failed standard corticosteroid and antifungal therapy. The anti-IL-5 mechanism of mepolizumab appears effective in treating ABPM complications by reducing eosinophil-mediated mucus plug formation.
  • Published in:Respirology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40125288; DOI: 10.1002/rcr2.70161
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