P2591 - Gastrointestinal Toxicity of Dupilumab: A Case of Drug-Induced Colitis

Hasan Alroobi, MD¹, Omar Khalil, MD¹, Prabhat Kumar, MD¹, Julie Lowman, MD¹, Maha Nayyar, MD¹, Sasha Mangray, MD²
1Virginia Commonwealth University Health System, Richmond, VA; 2Virginia Commonwealth University, Richmond, VA

Introduction:

Dupilumab is a monoclonal antibody that is used to treat conditions such as atopic dermatitis and asthma. Although it has transformed the management of these conditions, its association with gastrointestinal adverse events is emerging in clinical practice.

Case Description/

Methods:

A 32-year-old male with history of asthma and atopic dermatitis on Dupilumab presented with a 3-week history of subacute diarrhea. He reported up to 10 episodes of loose stools daily, associated with crampy abdominal pain, 5 lb weight loss, and occasional hematochezia. Initial workup revealed leukocytosis with eosinophilia, elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and a fecal calprotectin level of 1390 µg/g. Fecal leukocytes were positive, while stool cultures, including C. difficile, Strongyloides, and Toxocara, were negative. CT abdomen showed findings concerning for infectious or inflammatory enterocolitis. Colonoscopy showed diffuse severe inflammation in the rectum, sigmoid, and transverse colon, along with patchy inflammation in the ascending colon and cecum (Figure 1). Biopsy results confirmed active colitis with focal ulceration and prominent eosinophilic infiltration, without granulomas. The patient was started on 1 mg/kg per day of prednisone with great improvement in his symptoms.

Discussion:

The patient’s clinical course and histologic findings were most consistent with Dupilumab -induced colitis. Although inflammatory bowel disease (IBD) shares overlapping clinical and endoscopic features, the temporal relationship to Dupilumab initiation and lack of chronic architectural distortion on biopsy supports the former diagnosis. This case highlights the importance of recognizing Dupilumab as a potential cause of colitis in patients who present with unexplained diarrhea and eosinophilia following its initiation.


Figure: Figure 1: A. ascending colon; B. transverse colon; C. descending colon ; D. sigmoid colon

Disclosures:
Hasan Alroobi indicated no relevant financial relationships.
Omar Khalil indicated no relevant financial relationships.
Prabhat Kumar indicated no relevant financial relationships.
Julie Lowman indicated no relevant financial relationships.
Maha Nayyar indicated no relevant financial relationships.
Sasha Mangray indicated no relevant financial relationships.

Hasan Alroobi, MD¹, Omar Khalil, MD¹, Prabhat Kumar, MD¹, Julie Lowman, MD¹, Maha Nayyar, MD¹, Sasha Mangray, MD². P2591 - Gastrointestinal Toxicity of Dupilumab: A Case of Drug-Induced Colitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.