33863 Successful use of dupilumab for treatment of atopic dermatitis in a liver transplant patient

Abstract

There is a paucity of data regarding the use of dupilumab treatment of atopic dermatitis (AD) in solid organ transplant patients. We report a case of successful treatment of AD in an orthotopic liver transplant (LT) patient with dupilumab with favorable clinical response and no observed side effects throughout two years of treatment. A 65-year-old Caucasian female with history of orthotopic LT for cirrhosis 17 year prior, presented to dermatology clinic with 2-year history of a pruritic eruption involving bilateral extremities. Punch biopsy revealed spongiotic dermatitis with eosinophils, consistent with atopic dermatitis, allergic contact dermatitis, or id reaction. Photo-patch testing revealed positivity for methyldibromo glutaronitrile, benzalkonium chloride, and benzophenone. Despite numerous trials of medium- and high-potency topical steroids as well as intramuscular and oral corticosteroids, the patient experienced continued pruritus and repeated flares. Phototherapy and immunosuppressives including methotrexate and cyclosporine were contraindicated due to the patient’s photo-allergy and LT status on a stable dose of tacrolimus, respectively. After extensive discussion with the patient’s primary care and transplant teams, the decision was made to begin dupilumab. After 1 month of treatment, the patient experienced near clearance of rash, minimal flares that were easily controlled with adjunct topical corticosteroids, and a 90% improvement in subjective pruritus, with no adverse effects. This response was sustained throughout an additional 2 years of treatment. We report this case of successful dupilumab treatment of AD in a LT patient to raise awareness to the safety and efficacy of its use in this patient population.