D3.33 - Severe Eosinophilic Esophagitis: the Key Role of Biologics in Disease Management
Case report
Introduction:
To report a case of severe Eosinophilic Esophagitis (EoE) in remission in a patient undergoing treatment with Dupilumab.
Case report:
We report a case of a 20-year-old male, diagnosed with EoE since the age of 5, who presented with persistent dysphagia, food bolus impactions and frequent regurgitation since 4 months of age. He was referred at 22 months of age for suspected achalasia due to complaints of persistent vomiting since birth, with food intolerance and significant weight loss; Nissen fundoplication was performed, but symptoms remained and have been progressively worsening as an adult, with daily complaints, despite adhering daily medication, including Esomeprazol 40mg id, Fluticasone 500 µg bid, Montelukast 10mg, selective elimination diet (cow’s milk, gluten, egg and leguminous) and repeated esophageal dilations. His past medical history includes attention deficit hyperactivity disorder and in 2011, he underwent turbinectomy and septoplasty. The patient was referred to our Allergology and Immunology consultation and was evaluated with skin prick tests (SPT) to aeroallergens, that were positive to house dust mites; SPT and skin prick-prick tests to food allergens showed skin reactivity only to plum. Blood tests revealed a normal total IgE level and specific IgE levels for the different food mixtures were all negative. He was diagnosed with Allergic Rhinitis, which improved with avoidance of mites exposure.
The patient’s disease severity was evaluated using the Eosinophilic Esophagitis Severity Index (I-SEE), with a score of 25 points, indicating severe disease. Given the refractory nature of his disease and its impact on quality of life, the decision was made to initiate therapy with Dupilumab 300mg, weekly.
Results:
After 5 months of treatment with Dupilumab, the patient reported significant improvement with no episodes of vomiting or regurgitation, no occurrences of food bolus impactions, no complaints of abdominal pain and complaints of dysphagia decreased significantly.
Endoscopic findings, histophatological evaluation and the I-SEE score are presented in the attached table.
Conclusion:
This case highlights the challenges of managing refractory EoE, despite adhering to conventional treatments. The introduction of Dupilumab has demonstrated efficacy, with complete clinical and histological remission. This patient's improvement with Dupilumab showcases the potential of targeted therapies in reducing inflammation and improving quality of life. Further studies are needed to assess the long-term outcomes.
