P0742 - Severe EOE Flaring Asthma Exacerbation: A Case Report of Type-2 Inflammatory Diseases in a 20-Year-Old Male, Characterized by Eosinophilic Infiltration -- Successful Management With Dupilumab

Tahir Khan, MD¹, Zahoor Ahmad, ², Maimoona Zubair, ³, Ubaid Khan, ⁴, Drew Triplett, DO⁵
1Wright State University Boonshoft School of Medicine, Beavercreek, OH; 2Peshawar Medical College, Peshawar, North-West Frontier, Pakistan; 3Khyber Medical College, Peshawar, North-West Frontier, Pakistan; 4pak Internation Medical College, Peshawar, North-West Frontier, Pakistan; 5Wright State University Boonshoft School of Medicine, Dayton, OH

Introduction: Eosinophilic esophagitis (EoE) is an immune-mediated disease that can coexist with atopic conditions, including asthma and gastroesophageal reflux disease (GERD). GERD-related acid reflux can worsen asthma, and eosinophilic esophagitis (EoE) may further complicate asthma management. Dupilumab, an IL-4/IL-13 inhibitor, has shown efficacy in managing both conditions

Case Description/

Methods: A 20-year-old male with a history of moderate persistent asthma, recurrent exacerbations, and ongoing GERD symptoms arrived at the emergency department complaining of acute shortness of breath, chest tightness, and severe wheezing. Despite regular treatment with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs), he had experienced frequent asthma attacks over the past year, some severe enough to require intubation. During this visit, he also reported persistent GERD symptoms, such as heartburn and difficulty swallowing. An esophagogastroduodenoscopy (EGD) with biopsy showed significant eosinophilic infiltration, leading to a diagnosis of eosinophilic esophagitis (EoE). Treatment with topical budesonide and continued proton pump inhibitors (PPIs) improved his asthma control. However, due to lingering symptoms, Dupilumab—a therapy targeting interleukin-4 and interleukin-13—was added, further alleviating both his asthma and GERD symptoms without any subsequent exacerbations.

Discussion: This case emphasizes the need to consider eosinophilic esophagitis (EoE) in patients with difficult asthma and GERD. The use of Dupilumab, which targets eosinophilic inflammation, successfully managed both conditions and enhanced the patient's quality of life, highlighting the effectiveness of biologic therapies in complex cases.


Figure: EGD: linear furrowing and white executive changes of the distal Esophagus.

Disclosures:
Tahir Khan indicated no relevant financial relationships.
Zahoor Ahmad indicated no relevant financial relationships.
Maimoona Zubair indicated no relevant financial relationships.
Ubaid Khan indicated no relevant financial relationships.
Drew Triplett indicated no relevant financial relationships.

Tahir Khan, MD¹, Zahoor Ahmad, ², Maimoona Zubair, ³, Ubaid Khan, ⁴, Drew Triplett, DO⁵. P0742 - Severe EOE Flaring Asthma Exacerbation: A Case Report of Type-2 Inflammatory Diseases in a 20-Year-Old Male, Characterized by Eosinophilic Infiltration -- Successful Management With Dupilumab, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.