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Dupilumab-Induced Systemic Hypoperfusion in an Elderly Patient: A Case Report

Year: 2025

Type: article

Abstract: Background: Dupilumab is generally considered safe and effective for treating bullous pemphigoid (BP). We report the first case of recurrent hypoperfusion-induced cerebral infarction temporally associated with dupilumab administration in an elderly patient. Case Presentation: A 96-year-old male with BP, type 2 diabetes, and a history of stroke developed acute hypotension, depressed consciousness, and reduced oral intake within 24-72 hours after three separate dupilumab injections. Initial neuroimaging revealed watershed infarcts. Proactive volume expansion during one administration successfully averted new infarction, whereas lack of prophylactic hydration on another occasion precipitated a transient ischemic attack (TIA). Observations & Analysis: A significant temporal association was documented. The Naranjo Adverse Drug Reaction Probability Scale score was 8, indicating a probable association. The patient's advanced age, compromised cerebrovascular reserve, and mandatory discontinuation of antithrombotics created a hypervulnerable substrate. The hypotensive mechanism is hypothesized to involve IL-4/IL-13 pathway blockade, potentially disrupting endothelial function and vascular tone regulation. Conclusion & Clinical Implications: This case report describes a potential, albeit rare, serious adverse effect associated with dupilumab in an elderly individual at high risk. Based on this single experience, we suggest at least 72 hours of post-injection blood pressure monitoring for high-risk patients. Management could include administering prophylactic fluid replacement based on the patient's actual condition and critically reassessing concomitant antihypertensive regimens. This finding highlights the need for heightened clinical vigilance and suggests that the drug's safety profile in advanced-age patients may warrant further investigation.

Source: Journal of Inflammation Research

DOI: 10.2147/jir.s578682

Authors: Huishang Feng, Yao Liu, Xinglu Dong, Li Zhou

Institutions: Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Capital Medical University, Beijing Hospital of Traditional Chinese Medicine

Language: English

Topic: Pharmacovigilance and Adverse Drug Reactions

Subfield: Toxicology

Field: Pharmacology, Toxicology and Pharmaceutics

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836