Benralizumab
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Massive atelectasis: case report A 75-year-old woman developed massive atelectasis during treatment with benralizumab for asthma attack. The women was hospitalised due to an asthma attack. She had a medical history of uncontrolled bronchial asthma for which she used to take multiple medications for 28 years. She also had a history of sinusitis and rhinitis. Examination showed thickening of bronchial wall and diffusion of centrilobular nodules on both lungs. Laboratory investigations showed elevated CRP and neutrophil count, blood eosinophil count of 210–692/µL, fractional exhaled nitric oxide of 28 ppb and serum IgE of 159 IU/mL. Treatment with benralizumab [route and dose not stated] along with unspecified systemic corticosteroids and antibiotics were initiated. However, four months later, she developed severe respiratory failure and was re-hospitalised. The respiratory sound was decreased from the left lung and thoracic CT revealed atelectasis by mucoid impaction on the same side. Laboratory findings showed elevated level of CRP and neutrophil count, but blood eosinophils level was almost completely depleted with no serum IgE level elevation. Treatment with antibiotics, expectorants, and systemic corticosteroids was initiated. On the following day, her condition worsened due to massive atelectasis leading to tracheal deviation and nasal high-flow therapy. The thick mucus from the lower lobe bronchi and the left main bronchus was removed by bronchofiberscopy. Additionally, treatment with benralizumab was discontinued and erythromycin was initiated. On the 17th day of readmission, chest X-ray and thoracic CT revealed resolution of atelectasis. At 9 months follow-up visit, no recurrence was reported. The eosinophil depletion secondary benralizumab may have lead to massive atelectasis. Takimoto T, et al. Massive atelectasis by mucoid impaction in an asthma patient during treatment with anti-interleukin-5 receptor antibody. Respirology Case Reports 8: e00599, No. 6, Jun 2020. Available from: URL: http://doi.org/10.1002/rcr2.599 803497239
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Reactions 22 Aug 2020 No. 1818
