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已发表论文
度普利尤单抗致老年患者全身性低灌注 1 例报告
Authors Feng H , Liu Y, Dong X , Zhou L
Received 5 November 2025
Accepted for publication 20 December 2025
Published 31 December 2025 Volume 2025:18 Pages 18323—18329
DOI https://doi.org/10.2147/JIR.S578682
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Anish R. Maskey
Huishang Feng,1,2 Yao Liu,3 Xinglu Dong,4 Li Zhou4
1Department of Dermatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Second Clinical Medical School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Hepatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China; 4Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
Correspondence: Xinglu Dong, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China, Email arthasdxl@163.com Li Zhou, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China, Email zhouljk7211@163.com
Background: Dupilumab is generally considered safe and effective for treating bullous pemphigoid (BP). We report the first case of recurrent hypoperfusion-induced cerebral infarction temporally associated with dupilumab administration in an elderly patient.
Case Presentation: A 96-year-old male with BP, type 2 diabetes, and a history of stroke developed acute hypotension, depressed consciousness, and reduced oral intake within 24– 72 hours after three separate dupilumab injections. Initial neuroimaging revealed watershed infarcts. Proactive volume expansion during one administration successfully averted new infarction, whereas lack of prophylactic hydration on another occasion precipitated a transient ischemic attack (TIA).
Observations & Analysis: A significant temporal association was documented. The Naranjo Adverse Drug Reaction Probability Scale score was 8, indicating a probable association. The patient’s advanced age, compromised cerebrovascular reserve, and mandatory discontinuation of antithrombotics created a hypervulnerable substrate. The hypotensive mechanism is hypothesized to involve IL-4/IL-13 pathway blockade, potentially disrupting endothelial function and vascular tone regulation.
Conclusion & Clinical Implications: This case report describes a potential, albeit rare, serious adverse effect associated with dupilumab in an elderly individual at high risk. Based on this single experience, we suggest at least 72 hours of post-injection blood pressure monitoring for high-risk patients. Management could include administering prophylactic fluid replacement based on the patient’s actual condition and critically reassessing concomitant antihypertensive regimens. This finding highlights the need for heightened clinical vigilance and suggests that the drug’s safety profile in advanced-age patients may warrant further investigation.
Keywords: bullous pemphigoid, cerebral infarction, hypoperfusion, dupilumab, adverse drug reactions in elderly patients
1Department of Dermatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Second Clinical Medical School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Hepatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China; 4Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
Correspondence: Xinglu Dong, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China, Email arthasdxl@163.com Li Zhou, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China, Email zhouljk7211@163.com
Background: Dupilumab is generally considered safe and effective for treating bullous pemphigoid (BP). We report the first case of recurrent hypoperfusion-induced cerebral infarction temporally associated with dupilumab administration in an elderly patient.
Case Presentation: A 96-year-old male with BP, type 2 diabetes, and a history of stroke developed acute hypotension, depressed consciousness, and reduced oral intake within 24– 72 hours after three separate dupilumab injections. Initial neuroimaging revealed watershed infarcts. Proactive volume expansion during one administration successfully averted new infarction, whereas lack of prophylactic hydration on another occasion precipitated a transient ischemic attack (TIA).
Observations & Analysis: A significant temporal association was documented. The Naranjo Adverse Drug Reaction Probability Scale score was 8, indicating a probable association. The patient’s advanced age, compromised cerebrovascular reserve, and mandatory discontinuation of antithrombotics created a hypervulnerable substrate. The hypotensive mechanism is hypothesized to involve IL-4/IL-13 pathway blockade, potentially disrupting endothelial function and vascular tone regulation.
Conclusion & Clinical Implications: This case report describes a potential, albeit rare, serious adverse effect associated with dupilumab in an elderly individual at high risk. Based on this single experience, we suggest at least 72 hours of post-injection blood pressure monitoring for high-risk patients. Management could include administering prophylactic fluid replacement based on the patient’s actual condition and critically reassessing concomitant antihypertensive regimens. This finding highlights the need for heightened clinical vigilance and suggests that the drug’s safety profile in advanced-age patients may warrant further investigation.
Keywords: bullous pemphigoid, cerebral infarction, hypoperfusion, dupilumab, adverse drug reactions in elderly patients