Unclear septic state in a patient with intractable asthma treated with a biological therapy or ESR shouldn't be underestimated
Abstract
Patients with the "difficult to treat asthma" (DTA) can be characterized as the patients with uncontrolled asthma despite adherence to a set of complex treatment regimen of asthma. In some cases persistent eosinophilia might be reason for DTA.
Biological therapy using antibodies to interleukin 5 (IL-5) (mepolizumab) has brought considerable benefit to our patient enabling the long-term interruption of treatment with systemic corticosteroids. Enthusiasm for DTA control without systemic corticosteroid was after 18 months replaced by unclear sepsis with cutaneous symptoms and deep venous thrombosis of left leg, unsuccessfully treated with antibiotics obviously given to treat chronic colonization with Staphylococcus aureus.
Although the erythrocyte sedimentation rate (ESR) seems to be have limited meaning for clinical evaluation, and is usually replaced by the C-reactive protein test (CRP), in many cases the ESR could be the really important diagnostic indicator. This is especially true for some autoimmune disorders, as demonstrated in this case study, when the subsequent medical treatment with systemic corticosteroids returned the patient to normal life.