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Dupilumab-induced Diffuse Alveolar Hemorrhage
Tomoki Tamura1, Hiroya Okano1, Taisaku Koyanagi1
1Department of Respiratory Medicine, NHO Iwakuni Clinical Center, Japan.
Internal Medicine (Tokyo, Japan)
|May 15, 2024
Summary
Dupilumab, a treatment for severe asthma, can cause diffuse alveolar hemorrhage, a rare lung condition. Bronchoscopy helps differentiate this from eosinophilic pneumonia, another known dupilumab side effect.
Area of Science:
- Pulmonology
- Pharmacology
Background:
- Dupilumab is a monoclonal antibody used for severe asthma.
- Eosinophilic pneumonia is a recognized adverse effect of dupilumab therapy.
- Diffuse alveolar hemorrhage (DAH) has not been previously reported with dupilumab.
Observation:
- A 57-year-old male with severe asthma, refractory to oral steroids, was initiated on dupilumab.
- Four weeks post-initiation, the patient presented with symptoms suggestive of eosinophilic pneumonia.
- Bronchoscopy revealed DAH, confirmed by hemosiderin-laden macrophages in bronchoalveolar lavage fluid, with no eosinophils present.
Findings:
- The case demonstrates dupilumab as a potential cause of diffuse alveolar hemorrhage.
- Bronchoalveolar lavage findings, specifically the absence of eosinophils, distinguished DAH from eosinophilic pneumonia.
- Treatment with increased steroid dosage led to clinical improvement and resolution of pulmonary infiltrates.
Implications:
- This case expands the known spectrum of dupilumab-induced lung injury.
- Diagnostic bronchoscopy is crucial for differentiating DAH from eosinophilic pneumonia in patients on dupilumab.
- Clinicians should consider DAH in patients on dupilumab presenting with respiratory symptoms and pulmonary infiltrates.
