Abstract
Dupilumab, a dual inhibitor of IL-4 and IL-13 cytokine signaling, is indicated for
the treatment of moderate-to-severe atopic dermatitis, which leads to the control
of atopic dermatitis. The cytokines IL-4 and IL-13 are related to vascular inflammation,
which is mediated by vascular endothelial cells. We report the case of a 20-year-old
man with atopic dermatitis treated with dupilumab for half a year, who presented with
sudden onset of dizziness, nausea, and slight cerebellar ataxia. Brain magnetic resonance
imaging revealed acute infarction in the bicerebellar hemispheres. No risk factors
known to be associated with ischemic stroke in young adults were detected. We suspected
this ischemic stroke might be related to dupilumab. The administration of dupilumab
was discontinued, and he had no recurrence subsequently. IL-4 and IL-13, anti-inflammatory
cytokines secreted from T helper 2 cells, suppress proinflammatory cytokines. Therefore,
dupilumab, a dual inhibitor of IL-4 and IL-13 cytokine signaling, leads to the promotion
of coagulation and thrombosis. We speculate that the activation of proinflammatory
cytokines in vascular endothelial cells by the inhibition of IL-4 and IL-13 signaling
by dupilumab led to ischemic stroke even at a young age.
Key Words
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Article info
Publication history
Published online: April 04, 2020
Accepted:
February 13,
2020
Received in revised form:
February 10,
2020
Received:
December 2,
2019
Footnotes
Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104763
Copyright
© 2020 Elsevier Inc. All rights reserved.
