The incidence of chronic rhinosinusitis with nasal polyps has recently increased in Japan and other East Asian countries, and this disease is called eosinophilic chronic sinusitis (ECRS) in Japan. ECRS usually occurs in adults and is frequently accompanied by refractory bronchial asthma. However, its occurrence in children under 10 years of age is rare. Here, we present an unusual case of ECRS complicated by intractable asthma in an 8-year-old boy. Oral administration of prednisolone (10 mg/day) initially relieved the ECRS and bronchial asthma, but both returned during prednisolone dose reduction. Because nasal cavity-opening surgery was ineffective, oral administration prednisolone at 10 mg/day was continued. Pancytopenia was observed 16 months after the start of treatment, and the patient was admitted to our hospital. He was diagnosed with refractory cytopenia in childhood, but gradually improved after cyclosporine treatment. Although the dose of cyclosporine was therapeutic for asthma, it did not alleviate the asthma attacks, and the patient’s quality of life markedly decreased. We administered omalizumab even though its use was contraindicated by negative results in an inhalable antigen test. After the third administration of omalizumab, the asthma was better controlled and respiratory function improved; however, the nasal symptoms of ECRS persisted. Attempts to relieve these symptoms by increasing the therapeutic dose of omalizumab were only partially successful. We replaced omalizumab with mepolizumab; doing so slightly improved the sinusitis symptoms, but quality of life remained unsatisfactory. We repeated the nasal cavity-opening surgery. After surgery, the asthma and sinusitis were unchanged. Omalizumab effectively treated the severe combined asthma in a young patient, but its effect on sinusitis was insufficient. More cases and long-term follow-up data are needed to better evaluate the effectiveness of mepolizumab for treatment of ECRS.

中文翻译：

---

一名患有嗜酸性粒细胞性慢性鼻窦炎的小男孩接受奥马珠单抗治疗成功治疗严重哮喘：病例报告

日本和其他东亚国家近来伴有鼻息肉的慢性鼻窦炎发病率有所增加，这种疾病在日本被称为嗜酸性慢性鼻窦炎（ECRS）。ECRS 通常发生于成人，常伴有难治性支气管哮喘。然而，它在 10 岁以下的儿童中很少见。在这里，我们介绍了一个不寻常的 ECRS 病例，该病例在一名 8 岁男孩中并发顽固性哮喘。口服泼尼松龙（10 mg/天）最初缓解 ECRS 和支气管哮喘，但在泼尼松龙剂量减少期间均恢复。由于开鼻腔手术无效，继续口服泼尼松龙 10 mg/天。治疗开始16个月后观察到全血细胞减少，患者入院。他在儿童时期被诊断为难治性血细胞减少症，但在环孢素治疗后逐渐好转。环孢素虽然对哮喘有治疗作用，但并没有减轻哮喘发作，患者的生活质量明显下降。我们给予了奥马珠单抗，即使它的使用因可吸入抗原测试的阴性结果而被禁止。第三次服用奥马珠单抗后，哮喘得到较好控制，呼吸功能得到改善；然而，ECRS 的鼻部症状持续存在。通过增加奥马珠单抗的治疗剂量来缓解这些症状的尝试只取得了部分成功。我们用美泊利单抗代替了奥马珠单抗；这样做稍微改善了鼻窦炎的症状，但生活质量仍然不能令人满意。我们重复了鼻腔开放手术。手术后，哮喘和鼻窦炎没有变化。奥马珠单抗有效治疗了一名年轻患者的重症合并哮喘，但其对鼻窦炎的疗效不足。需要更多病例和长期随访数据来更好地评估美泊利单抗治疗 ECRS 的有效性。