P2.064: Chlamydia Pneumoniae in a Case of Treatment-Resistant Asthma

Introduction: Asthma is a heterogeneous disease with many clinical subtypes characterized by reversible airway obstruction and airway hyperresponsiveness. Evidence links Chlamydia pneumoniae infection with steroid-resistant asthma.

Case Description: 15-year-old previously healthy male presented for new onset wheezing and shortness of breath of 3 weeks duration. He initially presented with congestion, rhinorrhea, and cough, which then progressed to deeper chest congestion, shortness of breath and wheezing that persisted despite oral corticosteroid and bronchodilator therapy. PCR testing resulted positive for Chlamydia pneumoniae. His chest X-ray was read as bronchial thickening, but without focal pneumonia. The patient was treated with a 5-day course of Azithromycin, oral prednisone and twice daily low dose Symbicort with some improvement in symptoms, which then fully resolved 1 week after escalation to higher dose Symbicort treatment.

8 months prior, he experienced similar respiratory symptoms that failed to fully respond to oral corticosteroids, albuterol, and Amoxicillin, but eventually improved after Azithromycin. Since this time, he had experienced fluctuating respiratory symptoms exacerbated by viral illnesses and
exercise.

Discussion: The patient did not fully respond to initial oral corticosteroid and ICS/LABA therapy, but subsequently improved after Azithromycin and escalation of ICS/LABA treatment, suggesting treatment-resistant asthma. Chlamydia pneumoniae infection has been implicated in poorly controlled asthma and the addition of macrolide therapy has been shown to improve asthmatic symptoms and reduce wheezing in patients with CP infection or colonization.

Conclusion: PCR testing for Chlamydia pneumoniae should be considered in patients who present with acute asthma exacerbations that do not respond to initial therapy with oral corticosteroids.