Severe uncontrolled asthma with biologic therapy in a pediatric patient. The role of fungal sensitization, a case report

ABSTRACT
We present the case of M., a girl followed by our Center since 2020 for severe asthma. After an initial positive response to Mepolizumab, she experienced multiple asthma exacerbations with poor response to conventional therapies, increased IgE levels, peripheral eosinophilia, and new sensitization to Aspergillus, raising suspicion of Allergic Bronchopulmonary Aspergillosis (ABPA). Consequently, Mepolizumab was discontinued. However, due to insufficient diagnostic criteria to confirm ABPA, she was ultimately diagnosed with Severe Asthma with Fungal Sensitization (SAFS).
Her environmental history revealed significant mold exposure at home. Following environmental remediation and the initiation of Dupilumab therapy, she showed clinical improvement.

IMPACT STATEMENT
This case report underscores the diagnostic and therapeutic challenges of managing Severe Asthma with Fungal Sensitization (SAFS) in pediatric patients. By highlighting the role of environmental mold exposure and the clinical benefit of Dupilumab after Mepolizumab failure, the report emphasizes the importance of comprehensive environmental assessment and personalized biologic therapy. It contributes to the growing understanding of SAFS and supports the consideration of alternative biologics in children with uncontrolled asthma and fungal sensitization, even in the absence of clear ABPA criteria.

Received: Oct 31, 2024
Accepted: Jul 08, 2025
Published: Jul 10, 2025