Dupilumab for atopic dermatitis, a possible risk factor of juvenile ischemic stroke: a case report.
Dupilumab for atopic dermatitis, a possible risk factor of juvenile ischemic stroke: a case report.
复制标题
Dupilumab 治疗特应性皮炎，这是青少年缺血性中风的可能危险因素：病例报告。
DOI：
10.1016/j.jstrokecerebrovasdis.2020.104763
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Yokota T.
中科院分区：
文献类型：
--
作者：
Iwase R;Ishiguro T;Fujita K;Ishibashi S;Yokota T.
Dupilumab是一种IL-4和IL-13细胞因子信号传导的双重抑制剂，适用于治疗中度至重度特应性皮炎，从而控制特应性皮炎。细胞因子IL-4和IL-13与血管内皮细胞介导的血管炎症有关。我们报告一例20岁男性特应性皮炎患者接受dupilumab治疗半年后，突然出现头晕、恶心和轻微小脑共济失调。脑磁共振成像显示双小脑半球急性梗死。未检测到已知与年轻人缺血性卒中相关的危险因素。我们怀疑该缺血性卒中可能与dupilumab相关。停止dupilumab给药，随后未复发。IL-4和IL-13是辅助性T细胞2分泌的抗炎细胞因子，抑制促炎细胞因子。因此，dupilumab（IL-4和IL-13细胞因子信号传导的双重抑制剂）可促进凝血和血栓形成。我们推测，dupilumab通过抑制IL-4和IL-13信号传导激活血管内皮细胞中的促炎细胞因子，导致缺血性卒中，即使在年轻时也是如此。
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.