A case of severe pulmonary exacerbation in a young patient with cystic fibrosis in the era of CFTR modulators

• Published in: International journal of infectious diseases Vol. 147; p. 107190
• Main Authors: Lanfranchi, Chiara, Rizza, Carmela, Russo, Maria Chiara, Borzani, Irene, Angileri, Salvatore Alessio, Nazzari, Erica, Alicandro, Gianfranco, Blasi, Francesco, Daccò, Valeria
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.10.2024; Elsevier
• Subjects: Bronchial artery embolization; CFTR modulators; Cystic fibrosis; Elexacaftor; Hemoptysis; Ivacaftor; Pulmonary exacerbation; Tezacaftor; Ivacaftor; Hemoptysis; CFTR modulators; Cystic fibrosis; Elexacaftor; Tezacaftor; Bronchial artery embolization; Pulmonary exacerbation
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2024.107190

•ETI therapy revolutionizes CF care with improved lung function and quality of life.•CF patients on ETI may show unusual symptoms during respiratory exacerbations.•Recognizing subtle symptoms is crucial for timely intervention.•Vigilance is essential in managing CF patients on ETI.•New diagnostic methods are needed to enhance care. The introduction of CFTR modulator drugs like elexacaftor-tezacaftor-ivacaftor (ETI) has transformed the management of cystic fibrosis (CF), significantly improving symptoms, lung function, and quality of life, while reducing reliance on intravenous antibiotics. However, respiratory exacerbations in the CFTR modulators era remain poorly understood from both pathophysiological and clinical perspectives. We present the case of a 20-year-old Caucasian woman with CF (F508del/L1077P) who, after three years of ETI treatment, experienced a severe episode of hemoptysis, despite being almost asymptomatic in the weeks leading up to admission, requiring bronchial artery embolization. Following ETI treatment, auscultatory findings and FEV1 changes may be less significant, making the detection of respiratory exacerbation more challenging. This highlights the need for heightened vigilance in managing such cases and underscores the challenge of diagnosing and managing exacerbations in the era of modulators. Long term real-world studies are essential to comprehend the evolving course of the disease during ETI treatment.