背景:白细胞介素-5(IL-5)最近被证明在嗜酸性粒细胞介导的疾病中起关键作用,这意味着IL-5受体α链(IL-5Rα)抗体(benralizumab)可以有效对抗嗜酸性粒细胞性食管炎(EoE)。这里,我们介绍了一个病例,其中benralizumab显著改善了一位对现有治疗反应不足的EoE老年亚裔女性的症状和体征.病例介绍一位73岁的女性,有8年的支气管哮喘(BA)病史和7年的吞咽困难病史,因吞咽困难恶化到我们医院就诊。呕吐,胸痛,和吃饭的困难。血液生化结果显示白细胞的嗜酸性粒细胞分数增加(42.2%),常规胸部计算机断层扫描显示食管壁增厚。上消化道内镜检查显示粘膜水肿以及多个食管环,食管活检标本显示嗜酸性粒细胞浸润超过15个细胞/高倍视野。基于这些发现,她被BA诊断为EoE并发。我们首先服用20毫克/天的泼尼松龙,雷贝拉唑钠和液体布地奈德口服混悬液5个月;然而,他们是无效的,她的吞咽困难随着时间的推移恶化。然后,贝那利珠单抗与这些药物联合治疗开始.她的吞咽困难完全消失后2周开始benralizumab,上消化道内窥镜检查显示,在另一个6周后,临床表现完全消失。Benralizumab被给予她41个月,她的症状仍在缓解。此外,她在停用贝那利珠单抗后超过12个月无EoE复发.
结论:Benralizumab联合其他多种药物可显著改善老年EoE患者的症状和检查结果。此外,即使在停止benralizumab停药后,她也没有复发,提示贝那利珠单抗可能是EoE的合适治疗选择.
BACKGROUND: Interleukin-5 (IL-5) has recently been shown to play a crucial role in eosinophil-mediated diseases, implying that an IL-5 receptor alpha chain (IL-5Rα) antibody (benralizumab) can be effective against eosinophilic esophagitis (EoE). Here, we present a
case in which benralizumab significantly improved the symptoms and signs of an elderly Asian woman with EoE who had inadequate response to existing treatments.
Case presentation A 73-year-old woman with an 8-year history of bronchial asthma (BA) and a 7-year history of dysphagia presented to our hospital with worsening dysphagia, vomiting, chest pain, and difficulty in eating. Blood biochemical findings revealed an increase in the eosinophil fraction of white blood cells (42.2%), and a conventional chest computed tomography scan revealed esophageal wall thickening. An upper gastrointestinal endoscopy revealed mucosal edema as well as multiple esophageal rings, and esophageal biopsy specimens showed an eosinophilic infiltrate of more than 15 cells/ high power field. Based on these findings, she was diagnosed as EoE complicated by BA. We firstly administrated 20 mg/day of prednisolone, rabeprazole sodium and liquid budesonide oral suspension for 5 months; however, they were ineffective and her dysphagia worsened over time. Then, benralizumab treatment in combination with these drugs was started. Her dysphagia completely disappeared 2 weeks after starting benralizumab, and an upper endoscopy showed that the clinical findings had completely disappeared after another 6 weeks. Benralizumab was then given to her for 41 months, and her symptoms remained in remission. In addition, she had no EoE recurrence for more than 12 months after discontinuing benralizumab.
CONCLUSIONS: Benralizumab in combination with other multiple drugs significantly improved the symptoms and examination findings of an elderly patients with EoE. Furthermore, she experienced no recurrence even after discontinuing benralizumab withdrawal, suggesting that benralizumab could be an appropriate therapeutic option for EoE.