A Pediatric Case of Severe Atopic Dermatitis on Dupilumab Treatment and Pulmonary Tuberculosis

• DOI: 10.1111/pde.15862
• Publication Date: 2025-01-30T00:48:11Z
• Authors: Maria Efenesia Baffa; Leila Bianchi; Elisabetta Venturini; Nicola Pimpinelli; Samantha Berti
• Keywords: Dupilumab

Atopic dermatitis (AD) is a common disease affecting nearly 20% of the pediatric population in developed countries. The use biologic therapies, such as dupilumab, has considerably changed treatment AD. However, effects drugs on immune system may raise doubts and concerns, particularly special populations, like those with active or latent infections [1]. Here, we present case patient AD who was found to be infected Mycobacterium tuberculosis during dupilumab. Our 12-year-old boy suffered from severe since age 1 year been dupilumab for past 2 years. Prior this, he had treated topical steroids, tacrolimus, systemic ciclosporin. Before starting his EASI score ranged between 30 35, experienced itching, significant impact quality life. Additionally, hospitalized twice impetiginization lesions, which benzylpenicillin. At time this report, receiving 200 mg month. He screened, mother diagnosed smear negative pleuro-pulmonary (TB), resulting positive interferon-gamma release assay tuberculin skin test. Therefore, chest radiograph CT scan were performed, showing pulmonary lymphadenopathy reticular pattern tree-in-bud sign. isoniazid, rifampicin, pyrazinamide, ethambutol months plus an additional isoniazid accordance 4-month short-treatment protocol indicated uncomplicated form [2]. In agreement infectious diseases specialists managing patient, decided continue therapy Follow-up evaluations conducted monthly over period 6 months. Throughout period, did not experience any cutaneous adverse effects, TB carried out successfully. A performed at end normal. Dupilumab, antibody targeting interleukin-4 receptor alpha (IL-4Rα), approved aged older. Biologics IL-13/IL- 4Rα axis are apparently able compromise integrity tubercular granulomas, making bacterial reactivation very unlikely [3]. Consequently, screening required prior initiation therapy. recent expert consensus stated that JAK-inhibitors traditional drugs, methotrexate cyclosporine, should avoided patients untreated infection, while biologics AD, represent preferred option Moreover, two cases bullous pemphigoid one pemphigus vulgaris off-label started without complication further support notion safe particular group [4, 5]. conclusion, seems viable alternative TB. studies needed confirm its safety population. authors declare no conflicts interest. manuscript have given written informed consent publication their details. data findings study available corresponding author upon reasonable request.