Allergic bronchopulmonary aspergillosis in a patient with ankylosing spondylitis treated with adalimumab

• Published in: Respirology case reports 2021, Vol.9 (8), p.e00805-e00805
• Main Authors: Suzuki, Yudai, Takasaka, Naoki, Matsubayashi, Sachi, Kojima, Ayako, Shinfuku, Kyota, Hasegawa, Tsukasa, Yamada, Masami, Fujisaki, Ikumi, Seki, Aya, Seki, Yoshitaka, Ishikawa, Takeo, Kuwano, Kazuyoshi
• Format: Report
• Language: English
• ISSN: 2051-3380; 2051-3380
• DOI: 10.1002/rcr2.805

We herein report a case of allergic bronchopulmonary aspergillosis (ABPA) that occurred in a man treated with adalimumab for ankylosing spondylitis (AS). A 69-year-old man with a history of ankylosing spondylitis treated by adalimumab, an anti-tumour necrosis factor-α (TNF-α) antibody, developed cough and wheezing. Chest computed tomography showed obstruction of dilated left upper lobe bronchus by high attenuation mucus as well as central bronchiectasis. Both Aspergillus-specific immunoglobulin E (IgE) and Aspergillus precipitating antibody were positive and Aspergillus fumigatus was detected in a sputum culture. According to the new diagnostic criteria, the patient was diagnosed with ABPA. His condition rapidly improved after the withdrawal of adalimumab and initiation of prednisolone and itraconazole. Anti-TNF-α antibody might cause ABPA through both aggravation of the host's T-helper 2 immunological response and anti-fungal response.