[Asthma of difficult control linked to pulmonary thromboembolism and bronchopulmonary aspergillosis]

Rev Alerg Mex. Jan-Mar 2019;66(1):128-131. doi: 10.29262/ram.v66i1.352.
[Article in Spanish]

Abstract

Background: Inflammation caused by chronic diseases and the constant use of systemic corticosteroids could be linked to the increased incidence of venous thromboembolic disease.

Clinical case: A 47 year-old man with severe asthma of difficult control and allergic bronchopulmonary aspergillosis who, although the treatment was optimal, continued to have recurrent exacerbations and the need for systemic corticosteroids. He had edema in his left leg. Through venous Doppler ultrasound, deep vein thrombosis was confirmed; because of the images of the pulmonary V/Q gammagram, the presence of chronic pulmonary thromboembolism was suspected. 5 mg of apixaban were prescribed every 12 hours; in less than two months, symptom control was achieved without hospitalization, systemic corticosteroids or short-acting B2 agonists. Gradual withdrawal of omalizumab was started with good tolerance.

Conclusions: The important decrease of bronchial symptoms with the blood thinner confirmed the suspicion that the exacerbations were caused by chronic pulmonary thromboembolism.

Antecedentes: La inflamación ocasionada por las enfermedades crónicas y el uso recurrente de corticosteroides sistémicos podrían asociarse con mayor incidencia de enfermedad tromboembólica venosa. Caso clínico: Hombre de 47 años con asma severa de difícil control y aspergilosis broncopulmonar alérgica, quien a pesar de óptimo tratamiento continuaba con exacerbaciones recurrentes y necesidad de corticosteroides sistémicos. Presentó edema y en pierna izquierda. Mediante ecografía Doppler venosa se confirmó trombosis venosa profunda; por las imágenes del gammagrama V/Q pulmonar se sospechó tromboembolismo pulmonar crónico. Se prescribieron 5 mg de apixaban cada 12 horas; en menos de dos meses se logró el control de los síntomas, sin necesidad de hospitalizaciones, corticosteroides sistémicos o beta2-agonistas de acción corta. Se comenzó el retiro gradual del omalizumab, con buena tolerancia. Conclusiones: La disminución importante de los síntomas bronquiales con el anticoagulante confirmó la sospecha de que el tromboembolismo pulmonar crónico causaba las exacerbaciones.

Keywords: Asthma; Bronchopulmonary aspergillosis; Pulmonary thromboembolism; Steroids.

Publication types

  • Case Reports

MeSH terms

  • Aspergillosis, Allergic Bronchopulmonary / complications
  • Asthma / drug therapy*
  • Asthma / etiology
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / complications
  • Severity of Illness Index