How Can Dupilumab Cause Eosinophilic Pneumonia?

Abstract

Reports of eosinophilic pneumonia (EP) as a side effect of dupilumab administration are limited in previous studies. Herein, we report two cases in which EP developed subsequent to the administration of dupilumab for eosinophilic chronic rhinosinusitis (ECRS). Case 1: A 55-year-old woman presented with ECRS, eosinophilic otitis media, and bronchial asthma, and was treated with dupilumab for ECRS. Five weeks later, fever and dyspnea developed, and infiltration shadows were observed in her lungs. The peripheral blood eosinophil count (PBEC) was 3848/μL (26%), bronchoalveolar lavage fluid showed eosinophilic infiltration, and EP was subsequently diagnosed. Her condition improved following prednisolone treatment. Case 2: A 59-year-old man presented with fatigue and dyspnea after receiving dupilumab for ECRS. He had infiltrative shadows throughout his left lung field, and his PBEC was 4850/μL (26.5%). Prednisolone was initiated, and his condition improved. EP developed in both patients during the period of elevated PBEC after dupilumab administration, and dupilumab was suspected to be the causative agent in their EP. Hence, EP should be considered as a differential diagnosis when fever and dyspnea appear following dupilumab administration.

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

“…Dupilumab‐induced hypereosinophilia is reported in 4%–14% of patients who are treated with dupilumab for CRSwNP, asthma, or atopic dermatitis 72 . Although hypereosinophilic syndrome emerging during dupilumab treatment is rare, it constitutes a clinical and diagnostic challenge and should not be disregarded 73–78 . Increased eosinophil levels generally arise and return back to normal within the first half year of dupilumab treatment 79,80 .…”

“…72 Although hypereosinophilic syndrome emerging during dupilumab treatment is rare, it constitutes a clinical and diagnostic challenge and should not be disregarded. [73][74][75][76][77][78] Increased eosinophil levels generally arise and return back to normal within the first half year of dupilumab treatment. 79,80 dupilumab could be continued.…”

Monoclonal Antibodies in Idiopathic Chronic Eosinophilic Pneumonia: A Scoping Review

“…Dupilumab has only been used in one pediatric patient, who had a good response [24]. However, as we were selecting manuscripts and carrying out the detailed analysis, we found some case reports that have linked it as a cause of ICEP [28,29,30,31].…”

Eosinophilic pneumonia developed after dupilumab administration in a patient with atopic dermatitis

“…3 Kurihara et al reported two similar cases with high-grade eosinophilia and emphasized fever and dyspnea as initial symptoms of eosinophilic pneumonia. 4 Eger al. described four oral corticosteroid (OCS)-dependent asthma patients in whom IL-5 pathway biologics were switched to dupilumab leading to the development of eosinophilic pneumonia in one patient.…”

“…Nishiyama et al measured the serum cytokine levels in two cases of dupilumab‐associated eosinophilic pneumonia and found elevated IL‐5, but not in patients who did not develop dupilumab‐associated eosinophilic pneumonia 3 . Kurihara et al reported two similar cases with high‐grade eosinophilia and emphasized fever and dyspnea as initial symptoms of eosinophilic pneumonia 4 . Eger et al described four oral corticosteroid (OCS)‐dependent asthma patients in whom IL‐5 pathway biologics were switched to dupilumab leading to the development of eosinophilic pneumonia in one patient 5 .…”