Severe cutaneous reaction with initiation of dupilumab for atopic dermatitis and prurigo nodularis: An unusual adverse effect

JAAD Case Reports

Volume 49, July 2024, Pages 40-43

Leore Lavin MSc, Gabriella Chefitz BA, Deep Patel MD, Woong Kee Baek MD, Saakshi Khattri MD

Introduction

Dupilumab is a human immunoglobulin (Ig)-G4 monoclonal antibody that has demonstrated significant efficacy in treating various inflammatory skin conditions, including atopic dermatitis (AD) and prurigo nodularis.1,2 The most common treatment-emergent adverse events include nasopharyngitis (28.1%), conjunctivitis (19.5%), AD exacerbation (16.4%), upper respiratory infections (13.1%), and injection site reactions (9.7%).1

Severe cutaneous reactions have rarely been reported with dupilumab but have been noted with the use of many biologics, including anti-tumor necrosis factor therapeutics, interleukin 6, and interleukin 12/23 inhibitors. These reactions include, but are not limited to, new-onset psoriasis, erythema multiforme (EM), lupus-like reactions, and hypersensitivity reactions.3

Herein we report a patient with AD who developed a severe cutaneous drug eruption on sun exposed skin following initiation of dupilumab.

Probable dupilumab reaction, 10 days after loading dose received.

Case report

A 74-year-old woman with a past medical history of hypertension, hypothyroidism, and osteoporosis, presented to the clinic with AD. Other significant medical history included bronchiectasis with significant secondhand smoke exposure and sputum positive for Mycobacterium avium-intracellulare and acid-fast bacillus, along with Sjogren’s syndrome and rheumatoid arthritis...

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