Abstract
Background
Atopic dermatitis (AD), asthma, and eosinophilic esophagitis (EoE) may coexist because they share type 2 inflammatory pathways. Evidence for dupilumab in children with EoE and other gastrointestinal manifestations remains limited.
Case presentation
A 7-year-old girl had poorly controlled AD, recurrent asthma, EoE (>100 eosinophils/high-power field), and lower-density eosinophilic infiltration in gastric, ileal, and colonic biopsies. These extraesophageal findings did not uniformly satisfy proposed thresholds for definite non-EoE eosinophilic gastrointestinal disease. Severe AD despite topical therapy was the primary indication for dupilumab; the coexisting type 2 inflammatory disorders supported selection of a pathway-directed systemic treatment. Dupilumab was administered as a 600-mg loading dose followed by 300 mg subcutaneously every 4 weeks. Over 48 weeks, pruritus resolved, skin lesions markedly improved, wheezing did not recur, inhaled salmeterol/fluticasone was reduced, appetite improved, and vomiting ceased. Follow-up endoscopy showed a smooth esophagus and no obvious duodenal abnormality, although gastric inflammation and small ulcers persisted and repeat histology was unavailable. Total IgE decreased from >2,000 to 211.2 IU/mL; peripheral eosinophils decreased from 0.64 to 0.30 × 10⁹/L. No treatment-related adverse events occurred.
Conclusion
This case suggests that IL-4/IL-13 blockade may provide coordinated clinical benefit across multiple type 2 inflammatory organs. The gastrointestinal findings should be interpreted cautiously because symptom improvement was not confirmed by repeat biopsy.