D2.474 - Use of Dupilumab as treatment for Eosinophilic Enteritis: a case report

Eosinophilic enteritis (EE) is a rare subtype of eosinophilic gastrointestinal disease characterized by eosinophilic infiltration of the small intestinal wall, often accompanied by elevated peripheral eosinophil counts. Clinical manifestations include nausea, vomiting, abdominal pain, and weight loss. Diagnosis relies on endoscopic biopsies, and its prevalence appears to be increasing with the broader use of endoscopic procedures. Glucocorticoids remain the first-line therapy. We describe a case of successful treatment with dupilumab in a patient with glucocorticoid-dependent eosinophilic enteritis.

An 18-year-old male presented with persistent abdominal pain, vomiting, and diarrhea, in the context of eosinophilic enteritis diagnosed in 2023. Duodenal biopsy revealed marked eosinophilic infiltration (>40 eosinophils/HPF). In February 2025, hereditary alpha-tryptasemia was also diagnosed, and treatment with cromolyn sodium was initiated without clinical improvement.

Over the previous year, the patient required long-term oral prednisone, needing daily doses of 20 mg to maintain symptom control. His most recent hospital admission occurred during an attempt to taper prednisone to 5 mg/day.

Dupilumab was initiated at a dose of 300 mg subcutaneously every 15 days. After the first dose, a complete and sustained withdrawal of corticosteroids was achieved within 15 days, with the patient remaining asymptomatic.

This case illustrates the potential benefit of dupilumab in a patient with long-standing, glucocorticoid-dependent eosinophilic enteritis, a condition for which clinical experience with biologic therapy remains limited. Dupilumab may represent a promising therapeutic option for glucocorticoid-dependent eosinophilic gastrointestinal diseases, warranting further investigation.