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The efficacy of dupilumab in induction and maintenance of remission in an adult patient with steroid-dependent eosinophilic enteritis (EoN)

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Abstract

Eosinophilic enteritis (EoN) is associated with an eosinophilic infiltrate confined to the small intestine, but treatment options other than diet and corticosteroid therapy are scarce. There is only one report of the use of dupilumab for eosinophilic gastrointestinal disease, involving three pediatric patients. We report a case of successful induction of remission with dupilumab in a 53 year-old female patient with steroid-dependent EoN. The patient presented to the emergency room with uncontrollable abdominal pain and CT revealed a thickened ileal wall and small amount of ascites. Despite no abnormalities on endoscopy, histological examination revealed numerous eosinophilic infiltrates (> 100/HPF) and degranulation in the ileal lamina propria, diagnosing the patient with EoN. The patient achieved clinical remission with prednisolone, but EoN relapsed during tapering. Long-term steroid therapy was inappropriate due to mandibular osteomyelitis and osteoporosis, and she was switched to 9 mg budesonide, an intestine-soluble topical steroid without effect. Dupilumab administration resulted in resolution of abdominal pain, and remission was maintained after discontinuation of budesonide. Histological remission was confirmed 2 months after dupilumab administration. This is the first report of remission induced and maintained with dupilumab in an adult patient with EoN.

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Abbreviations

EGID:

Eosinophilic gastrointestinal disease

EoE:

Eosinophilic esophagitis

EoN:

Eosinophilic enteritis

Non-EoE EGID:

EGID distal to the esophagus

NSAIDs:

Non-steroidal anti-inflammatory drugs

TARC:

Thymus- and activation-regulated chemokine

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Correspondence to Sho Watanabe.

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The authors state that they have no conflict of interest.

Ethical approval

The administration of budesonide and dupilumab to this EoN patient with severe asthma was done after obtaining the approval of the ethics review committee of Soka municipal hospital and the informed consent of the patient.

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Written informed consent was given by the patient for the publication of this manuscript. Identifying information, aside from age and sex, was removed and the images provided were anonymized to protect patient confidentiality.

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Watanabe, S., Uchida, H., Fujii, R. et al. The efficacy of dupilumab in induction and maintenance of remission in an adult patient with steroid-dependent eosinophilic enteritis (EoN). Clin J Gastroenterol 16, 527–531 (2023). https://doi.org/10.1007/s12328-023-01799-6

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