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.