Effective use of dupilumab for eosinophilic gastritis concomitant with severe asthma.

Abstract

Background: Eosinophilic gastrointestinal diseases (EGIDs) are chronic immune-mediated inflammatory disorders characterized by gastrointestinal symptoms and eosinophilic inflammation in specific regions of the gastrointestinal tract. "Eosinophilic gastritis" (EoG) refers to the condition in which the stomach is involved. In patients with EoG, approved treatment options are restricted despite the high mortality associated with the condition. Dupilumab is a human monoclonal antibody directed against the interleukin (IL)-4 receptor α subunit and inhibits the signaling pathways of both IL-4 and IL-13. The real-world data on the effectiveness of dupilumab for EoG are limited. We present the case of a patient with EoG and accompanying severe asthma who demonstrated improvement with dupilumab administration.

Case presentation: A 35-year-old woman who had been treated for asthma complained of worsening intermittent upper abdominal pain. Her dyspnea aggravated and she was admitted to our hospital for asthma exacerbation. Despite the improvement in her asthma symptoms with systemic corticosteroids, her abdominal pain persisted. Upper gastrointestinal endoscopic mucosal biopsy revealed eosinophilic cell infiltration; therefore, the patient was diagnosed with EoG. Dupilumab administration was initiated for asthma, while improvement of secondary EoG was expected. Following dupilumab administration, both EoG and asthma symptoms, disease control, laboratory findings, endoscopic findings, and pathological findings improved. No adverse events have been reported after the dupilumab treatment.

Conclusion: This case report supports that dupilumab could be an effective treatment option for EoG and accompanying severe asthma.