A case of complicated chronic rhinosinusitis with nasal polyps treated with dupilumab, in the UK: a case report

Background Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the nasal and paranasal mucosa, affecting approximately 1 in 10 people and contributing to substantial symptom burden and impaired quality of life. Phenotypically, CRS is classified into two subtypes based on the presence or absence of nasal polyps—benign inflammatory outgrowths of the nasal mucosa—which occur in roughly 20% of affected individuals. Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is predominantly driven by type 2 (T-helper 2) inflammation, typically characterised by eosinophilic infiltration and involvement of interleukins, such as IL-4, IL-5, and IL-13. Given this immunopathology, biologic therapies, such as Dupilumab, Omalizumab and Mepolizumab, initially developed for asthma, have shown efficacy in this patient population. They are readily used in the United States (US) and European Union (EU) in cases of severe CRSwNP, but are not currently authorised for NHS use. Case presentation We describe a case of severe, refractory CRSwNP complicated by recurrent left periorbital abscess and dehiscence of the floor of the left frontal sinus in a white, male patient in his sixties. The condition persisted despite multiple surgical polypectomies, repeated courses of systemic antibiotics (oral and intravenous), topical and systemic steroids, and drainage of periorbital collections. At the time, Dupilumab was not routinely commissioned by the NHS for this indication. However, following a successful application to NHS England’s Individual Funding Request (IFR) process, funding for Dupilumab was granted. Conclusions Treatment with Dupilumab led to complete resolution of symptoms and significant improvement in quality of life. The patient remains under regular follow-up with ongoing clinical stability and no reported adverse effects.