Inflammatory exacerbation of hepatic alveolar echinococcosis during dupilumab therapy: A case report

Alveolar echinococcosis is a rare but potentially fatal parasitic disease characterized by slow, infiltrative hepatic growth. Disease progression is strongly influenced by host immune status, and atypical courses have been reported in immunocompromised individuals. Dupilumab, a monoclonal antibody targeting interleukin-4 and interleukin-13 signaling, is increasingly used for atopic diseases; however, its impact on latent helminth infections remains unclear. We report a case of hepatic alveolar echinococcosis with pleural involvement occurring during dupilumab therapy, suggesting a possible interaction between targeted immune modulation and disease behavior.

A 29-year-old man presented with acute epigastric and left flank pain, fever, and inflammatory markers. Computed tomography revealed a calcified hepatic lesion protruding from the left lateral segment, accompanied by newly developed subdiaphragmatic and left pleural fluid collections suggestive of abscess formation. The patient had been receiving dupilumab for atopic dermatitis. Serological testing confirmed alveolar echinococcosis. Despite broad-spectrum antibiotic therapy, inflammation persisted, and surgical resection was performed, including partial hepatectomy with resection of the diaphragm and pleura. Histopathological examination demonstrated laminated parasitic structures consistent with echinococcal infection in hepatic and pleural tissues, without pulmonary parenchymal involvement. Postoperatively, the patient recovered well and was started on long-term antiparasitic therapy.

This case highlights an inflammatory exacerbation of hepatic alveolar echinococcosis with pleural extension during dupilumab therapy. Although causality cannot be established, inhibition of type 2 immune pathways may be associated with atypical inflammatory manifestations of latent helminth infections. Clinicians should remain vigilant for inflammatory presentations when prescribing biologic agents, particularly in endemic regions.