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DOI: 10.1055/s-0042-1746463
Case presentation of a CRSwNP patient with severe cortisone-induced osteoporosis and dual biologics therapy with denosumab and dupilumab
Introduction Prior to biologic approvals, severe forms of chronic rhinosinusitis with nasal polyposis (CRSwNP) were often treated with oral corticosteroids (OCS). Little is known about the frequency of OCS-induced side effects such as osteoporosis in CRSwNP patients. In the case presentation, we report a case of a CRSwNP patient with severe OCS-induced osteoporosis.
Method Case presentation.
Results Presentation of a 63-year-old patient with CRSwNP, asthma and ASA intolerance. Two nasal sinus operations were performed. CRS or asthma symptoms were treated 3 times a year with short-term OCS or long-term therapy with 5 mg OCS. After a thigh fracture after an accident and a later spontaneous tibia fracture, the orthopedist diagnosed severe osteoporosis. Therapy with denosumab (antibody to the receptor activator of nuclear factor-kappa-B ligand RANKL) was initiated by the orthopedist 5 years ago. The clinical findings showed an overall NP score of 5 and an FEV-1 of 83% when presented in the rhinologic consultation, medication with mometasone furoate, montelukast and formoterol/beclomethasone. Therapy with dupilumab (anti IL-4/ IL-13 antibody) was initiated. The control examination after 4 months showed an overall NP score of 2. Short-term therapies with OCS had not been carried out since initiation of dupilumab therapy.
Conclusion Basically, systemic OCS therapy is associated with serious side effects. Therefore, the use of OCS in the CRSwNP should be critical considered. A positive effect of dupilumab therapy on CRSwNP is the reduction of OCS.
Publikationsverlauf
Artikel online veröffentlicht:
24. Mai 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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