Sucesso no manejo da aspergilose broncopulmonar alérgica (ABPA) com o uso de mepolizumabe: relato de caso

Maria Eduarda Trocoli Zanetti; Gabriel Veloso Araujo-Neto; Renata Gomes Oliveira; Natalia Dias Melo; Nathália Ventura Stefli; Ana Claudia Rossini Clementina; Laura Cardoso Brentini; Lais Fukuda Cuoghi; Anne Marielle Camargo; Letícia Wellingta Santos Costa1; José Eduardo Lemos1; Mariana Paes Leme Ferriani; Luísa Karla Arruda

doi:10.4322/2526-5393.26051317

Relato de Caso

Sucesso no manejo da aspergilose broncopulmonar alérgica (ABPA) com o uso de mepolizumabe: relato de caso

Successful management of Allergic Bronchopulmonary Aspergillosis (ABPA) with Mepolizumab: a case report

Maria Eduarda Trocoli Zanetti, Gabriel Veloso Araujo-Neto, Renata Gomes Oliveira, Natalia Dias Melo, Nathália Ventura Stefli, Ana Claudia Rossini Clementina, Laura Cardoso Brentini, Lais Fukuda Cuoghi, Anne Marielle Camargo, Letícia Wellingta Santos Costa1, José Eduardo Lemos1, Mariana Paes Leme Ferriani, Luísa Karla Arruda

http://dx.doi.org/10.4322/2526-5393.26051317 Arq Asma Alerg Imunol, vol.10, n2, e26051317, 2026

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Resumo

A Aspergilose Broncopulmonar Alérgica (ABPA) representa um desafio terapêutico devido à refratariedade frequente e à dependência de corticosteroides sistêmicos. A inflamação Tipo 2, mediada por eosinófilos e IgE, é central na patogênese da doença. Terapias biológicas anti-IL-5 surgem como alternativas promissoras para casos complexos. Este relato descreve o manejo bem-sucedido de ABPA refratária com mepolizumabe. Paciente masculino, 57 anos, com asma grave e ABPA diagnosticada com base em critérios clínicos, laboratoriais e radiológicos. Apesar do tratamento otimizado com itraconazol e corticosteroides sistêmicos, o paciente evoluiu com exacerbações recorrentes e declínio da função pulmonar. Diante da falha terapêutica convencional, iniciou-se mepolizumabe, 100 mg, por via subcutânea. A resposta clínica e laboratorial foi rápida e sustentada. Observou-se redução drástica dos eosinófilos séricos e queda dos níveis de IgE total. Ao longo de 12 meses de seguimento, houve cessação completa das exacerbações e controle dos sintomas respiratórios. A intervenção permitiu o desmame gradual do corticosteroide por via oral. Exames de imagem demonstraram resolução significativa das impactações mucoides em relação aos exames basais. Não foram registrados eventos adversos. O mepolizumabe demonstrou eficácia robusta no controle da ABPA refratária em paciente com fenótipo eosinofílico grave. O tratamento promoveu a estabilização clínica, a melhora radiológica e viabilizou a redução da carga de corticosteroides sistêmicos. Estes dados reforçam o potencial dos antagonistas de IL-5 como estratégia terapêutica modificadora da doença na ABPA.

Palavras-chave

Aspergilose Broncopulmonar Alérgica; Asma; Aspergillus fumigatus; imunobiológicos; mepolizumabe.

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) poses a therapeutic challenge due to its frequent refractoriness and dependence on systemic corticosteroids. Type 2 inflammation, mediated by eosinophils and IgE, is central to the pathogenesis of the disease. Anti-IL-5 biologic therapies are emerging as promising alternatives for complex cases. This report describes the successful management of refractory APBA with mepolizumab. A 57-year-old male patient with severe asthma and APBA was diagnosed based on clinical, laboratory, and radiological criteria. Despite optimized treatment with itraconazole and systemic corticosteroids, the patient experienced recurrent exacerbations and declining lung function. Given the failure of conventional therapy, subcutaneous mepolizumab 100 mg was initiated. The clinical and laboratory response was rapid and sustained. A dramatic reduction in serum eosinophils and a decrease in total IgE levels were observed. Over 12 months of follow-up, there was a complete cessation of exacerbations and control of respiratory symptoms. The intervention allowed for the gradual tapering of oral corticosteroids. Imaging studies demonstrated significant resolution of mucoid impaction compared to baseline findings. No adverse events were reported. Mepolizumab demonstrated robust efficacy in controlling refractory ABPA in a patient with a severe eosinophilic phenotype. The treatment promoted clinical stabilization and radiological improvement and enabled a reduction in the systemic corticosteroid load. These data reinforce the potential of IL-5 antagonists as a disease-modifying therapeutic strategy in ABPA.

Keywords

Allergic Bronchopulmonary Aspergillosis; Asthma; Aspergillus fumigatus; biologics; mepolizumabe.

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Submetido em:
26/01/2026

Aceito em:
25/03/2026