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Case Reports
. 2024 Jul 26;3(4):100314.
doi: 10.1016/j.jacig.2024.100314. eCollection 2024 Nov.

Granulomatous hyperinflammatory state induced by dupilumab treatment for eosinophilic esophagitis

Kanak V Kennedy  1   2 , Anna Costello  2   3 , Melissa A Lerman  2   3 , Jon M Burnham  2   3 , Aoife Corcoran  2   4 , Joseph Piccione  2   4 , Alexandra Grier  2   5 , Kathleen Sullivan  2   5 , Terri Whitehorn-Brown  2   5 , Caitlin J Alexander  6 , Laura S Finn  6 , Benjamin J Wilkins  6 , Amanda B Muir  1   2
Affiliations
Case Reports

Granulomatous hyperinflammatory state induced by dupilumab treatment for eosinophilic esophagitis

Kanak V Kennedy et al. J Allergy Clin Immunol Glob. .

Abstract

We present the first case of a dupilumab-induced hyperinflammatory state in the setting of underlying eosinophilic esophagitis characterized by multisystem granulomatous inflammation. Although clinical trial data and subsequent real-world experience support dupilumab as a highly effective therapy for eosinophilic esophagitis, close monitoring for development of adverse symptoms following initiation remains paramount.

Keywords: Dupilumab; adverse effect; biologics; eosinophilic esophagitis; granuloma.

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Conflict of interest statement

Disclosure of potential conflict of interest: A. B. Muir receives consulting fees from Bristol-Meyers Squib, Nexstone Immunology, and 10.13039/100009857Regeneron, as well as research funding from 10.13039/100030947Allakos and Morphic. The rest of the authors declare that they have no relevant conflicts of interest.

Figures

Fig 1
Fig 1
Histopathologic findings in the setting of dupilumab-induced hyperinflammatory response. Necrotizing granuloma (left [yellow star]) noted on a distal esophageal biopsy sample and nonnecrotizing granuloma (right [yellow star]) on a hilar lymph node biopsy sample.
Fig 2
Fig 2
A chest computed tomography image (left) demonstrating perihilar lymphadenopathy (blue arrows) improved significantly (right) after discontinuation of dupilumab therapy.
See this image and copyright information in PMC

References

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