Dupilumab-related type 1 diabetes in a patient with atopic dermatitis: a case report

Dupilumab, a humanized monoclonal antibody that inhibits both interleukin (IL)-4 and IL-13 signals, is used as a treatment for a variety of allergic diseases including atopic dermatitis. We experienced a case of dupilumab-related type 1 diabetes in a patient with atopic dermatitis. An 18-year-old female presented with thirst and polydipsia seven months after initiating dupilumab therapy for atopic dermatitis and was found to have marked hyperglycemia with ketosis. She was positive for anti-glutamic acid decarboxylase antibody, leading to the diagnosis of type 1 diabetes. She carried human leukocyte antigen (HLA) genes associated with type 1 diabetes. Most type 1 diabetes is considered a T-helper (Th) 1 type autoimmune disease, whereas IL-4 and IL-13, which are Th2 cytokines, play inhibitory roles in the pathogenesis of type 1 diabetes. This case implies that dupilumab might contribute to the development of type 1 diabetes in individuals with a genetic background of type 1 diabetes via relative Th1 dominance. To our knowledge, this is the first case of the development of type 1 diabetes during dupilumab therapy. As dupilumab therapy might accelerate the development of type 1 diabetes, it is important to note cases like this case to clarify the pathogenic mechanisms underlying dupilumab-related type 1 diabetes.