Abstract Introduction Dupilumab is a biologic medication that is gaining wide spread use for asthma, COPD, nasal polyps and many other conditions. It is a human monoclonal IgG4 antibody that inhibits IL-4 and IL-13 signaling thereby reducing inflammation. Adverse effects most commonly include injection site reactions but overall it is well tolerated. Herein, we present a case of suspected Dupilumab induced Sarcoidosis. Case description The case involves a 60 year old with a past medical history of nasal polyps and sinusitis (on Dupilumab since 2020) and OSA who presented to his PCP with episodes of hemoptysis and night sweats. A CT chest scan was obtained which showed multiple subcentimeter nodules and bilateral hilar lymphadenopathy - concerning for pulmonary sarcoidosis. Patient then underwent bronchoscopy with EBUS and biopsy. Biopsy results showed non necrotizing granulomas consistent with Sarcoidosis.The patient had no family history of Sarcoidosis and no personal history of occupational exposures or immunodeficiency. On chart review it was found that Dupilumab could be a cause of Sarcoidosis. As patient had resolution of nasal polyps and symptoms that had warranted him starting Dupilumab - he was willing to trial stopping this medication. Unfortunately, after 80 days he had persistent productive cough and congestion for which he resumed his Dupilumab. Discussion Dupilumab is a biologic medication that has great efficacy in asthma, COPD, nasal polyps and many other conditions. It is generally very well tolerated however there are rare cases of serious adverse effects including medication induced sarcoidosis.Drug induced sarcoidosis-like reactions (DISR) are systemic granulomatous reactions that occur in temporal associated with certain medications. Medications that have been implicated in DISR include immune checkpoint inhibitors, TNF-antagonists, and HAART. IL-4 and IL-13 inhibitors, such as Dupilumab, more rarely trigger DISR but there are reported cases. The mechanism of action is thought to be when Dupilumab inhibits the Th2 inflammatory pathway, it leads to an imbalance and possible enhancement of Th1 response which can in turn lead to granuloma formation and Sarcoidosis pathogenesis.This case represents a case of suspected Dupilumab induced sarcoidosis. This is a rare adverse effect and DISR more typically presents in months following initiation of the medication. However, as pulmonary sarcoid can have a smoldering presentation with a long period of being asymptomatic it is possible this patient was having physiologic changes without symptoms. As Dupilumab becomes increasingly utilized it is important for providers to be aware of this rare but significant adverse effect. This abstract is funded by: None
Pasichnik et al. (Fri,) studied this question.