Resolution of corticosteroid-induced diabetes in allergic bronchopulmonary aspergillosis with omalizumab therapy: a novel approach.

摘要

Allergic bronchopulmonary aspergillosis (ABPA) occurs in up to 15% of patients with cystic fibrosis (CF) (1). Clinically, the disease manifests by symptoms consistent with bronchial asthma along with wheezing, pulmonary infiltrates, and bronchiectasis. Variable immunologic responses to As-pergillus fumigatus antigens are observed including peripheral blood eosinophilia, prick skin test reactivity, increased levels of total serum immunoglobulin (IgE), the presence of precipitating antibodies and increased specific serum IgE and IgG antibodies to A fumigatus (2,3). Treatment of ABPA targets the inflammatory and immunological activity with cor-ticosteroids in concert with an overall reduction of airway fungal load with antifungal agents (4). Long-term treatment is often required because of repeated exacerbations when cor-ticosteroid treatment is tapered. Owing to chronic systemic corticosteroid use, serious adverse events frequently include insulin resistance, hyperglycemia, and chronic diabetes (5). Allergic bronchopulmonary aspergillosis frequently results in severe worsening of the respiratory condition in patients with chronic obstructive lung disease, particularly cystic fibrosis. Treatment can result in steroid dependency and serious adverse events (6). Several case reports of improvement of respiratory symptoms and lung function after treatment with anti-IgE antibody (omalizumab) in cystic fibrosis patients with ABPA have been described (7,8). While previous benefits of omalizumab have been noted in ABPA, this report focuses on the subgroup of CF patients with steroid-induced hyperglycemia. As systemic corticosteroids are a mainstay of therapy in ABPA, this subgroup requires intensive glucose monitoring while on steroids. We report a case of corticosteroid-induced diabetes in a patient with CF and ABPA subsequently treated with omalizumab.