A 47-year-old African American female with a history of asthma since childhood, stage IV sarcoidosis, and bilateral upper lobe aspergillomas was seen in follow-up for her multiple pulmonary disorders. She also had a history of frequent asthma exacerbations, an elevated total serum IgE level, and very high level positivity for serum Aspergillus precipitins. After several years of therapy with relatively high-dose corticosteroids and multiple antifungal agents for allergic bronchopulmonary aspergillosis, she had developed diabetes mellitus and osteoporosis and had gained over 60 pounds. Multiple prior attempts to wean her from corticosteroids had failed. The patient was subsequently started on omalizumab with significant clinical improvement and successful cessation of corticosteroid therapy. When she later temporarily discontinued omalizumab therapy for insurance reasons, she experienced symptomatic deterioration, which was promptly reversed upon reinitiation of this agent. We present this case to illustrate a novel and effective use of omalizumab (which inhibits IgE-mediated activation of mast cells and basophils) in a patient with multiple pulmonary disorders, including sarcoidosis, aspergillomas, asthma, and allergic bronchopulmonary aspergillosis.
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