case_images: PMC11196399_01
case_images: Chest X-ray (A) and chest CT (B-D) on the day of the first visit to the hospital. Bilateral ground-glass opacities in the upper lobes and bronchial wall thickening in the lower lobes. Chest X-ray on day 10 from starting therapy (H). Bilateral ground-glass opacities disappeared. Chest CT performed 1 month after starting therapy (E-G). Bilateral ground-glass opacities and bronchial wall thickening disappeared. Sinus CT on the day of the first visit to the hospital (I). Bilateral sinusitis exists in the maxillary sinus. Sinus CT 3 months after starting therapy (J). Bilateral sinusitis was improved.
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case_images: PMC11196399_01_fmed-11-1381261-g001.jpg
case_images: fig1
case_images: Chest X-rays showed infiltration shadows in the right upper and lower lung fields, chest computed tomography (CT) revealed predominant bilateral infiltration shadows in the upper lobes, which extended to both lower lobes, and sinus CT showed bilateral sinusitis (Figures 1A-D,I). After 10 days, the asthma symptoms and chest XP markedly improved (Figure 1H), and after 1 month, the bilateral shadows disappeared (Figures 1E-G). At the same time, a marked improvement in sinusitis was observed (Figure 1J).
case_images: Clinical course of therapy for the present case. Initial therapy was started (day 0) with the combination of oral corticosteroid (prednisolone, 10 mg/day), inhaled fluticasone furoate/vilanterol (FF/VI, 200/25 mug/day), and tezepelumab (210 mg/month). Prednisolone was administered at 10 mg/day for 10 days. Then, the dose was reduced to 8 mg/day and continued for 1 month before being reduced to 3 mg/day during the next month. Two months after starting treatment, prednisolone was discontinued, while FF/VI and tezepelumab were continued.
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case_images: fig2
case_images: Treatment began with prednisolone (10 mg/day), inhaled fluticasone furoate/vilanterol (FF/VI, 200/25 mug/day), and tezepelumab (210 mg/month) (Figure 2).
case_images: Clinical course of the parameters. (A) Asthma control test (ACT), (B) mean change from the baseline score of the asthma control questionnaire (ACQ-5), (C) forced expiratory volume in 1 s, (D) fractional exhaled nitric oxide (FeNO), (E) peripheral eosinophil count, and (F) NH3 in peripheral blood. Baseline: measured on day 0, before starting therapy.
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case_images: PMC11196399_01_fmed-11-1381261-g003.jpg
case_images: fig3
case_images: After 2 months of therapy, the asthma symptoms, pulmonary function, circulating eosinophils, and FeNO content markedly improved, but the NH3 content increased from 43 mug/dL before therapy to 75 mug/dL at 2 months (Figures 3A-F).