Case Report: Rare Dupilumab-Associated Pulmonary and Extrapulmonary Tuberculosis

Dupilumab, a fully human monoclonal antibody targeting the interleukin-4 receptor alpha (IL-4Rα), has revolutionized the management of moderate-to-severe atopic dermatitis (AD) by inhibiting signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13). Our case report is about a 71-year-old man with a history of AD who developed pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) after treatment with dupilumab. The mechanism is unclear, but it may be related to the fact that dupilumab inhibits the expression of pro-inflammatory response-related genes and the innate immunity of macrophages, thereby aggravating TB infection. This is the first report of PTB and EPTB associated with dupilumab treatment, and it may be useful for clinicians to enhance TB vigilance in patients receiving dupilumab therapy, particularly in endemic regions.