case_images: PMC10801202_01
case_images: Dupilumab treatment impact on rash, score, and IgE levels over 16 weeks. (A-D) Upon initial examination, the patient presented with symmetrical erythema across the head (A), face, trunk (B, C), and proximal extremities (D). Additional symptoms included minor papules, scratch marks on the back and thighs, epidermal defects, and dry skin. (I) A skin biopsy from the shoulder revealed mild hyperkeratosis, acanthosis, slight spongiosis, and focal basal cell liquefaction degeneration, indicative of chronic superficial dermal perivasculitis. (E-H, J, K) Following a 16-week treatment period with dupilumab, the patient achieved an EASI-90 remission (J), accompanied by significant reductions in multiple atopic dermatitis scores and IgE levels (K). In addition, the CAT score for chronic respiratory diseases showed substantial improvement (J). BAS, body surface area; EASI, Eczema Area and Severity Index; SCORDA, Scoring Atopic Dermatitis Index; ADCT, Atopic Dermatitis Control Tool; NRS, Numerical Rating Scale; DLQL, Dermatology Life Quality Index; CAT, Chronic Obstructive Pulmonary Disease Assessment Test.
case_images: fimmu-14-1277734-g001.jpg
case_images: PMC10801202_01_fimmu-14-1277734-g001.jpg
case_images: f1
case_images: Physical and auxiliary examinations of the patient are shown in  Figure 1 . By the return visit at 16 weeks, the patient had reached eczema area and severity index (EASI)-90 ( Figure 1 ).
case_images: Temperature, EOS, and lung CT changes before, during, and after hospitalization for pulmonary symptoms. (A) A lung CT scan conducted 3 months prior to hospitalization revealed a history of bilateral chronic bronchitis and emphysema, along with several old lesions beneath the pleural space of the right lower lobe. (B) On the day of hospitalization, the lung CT scan showed scattered ground-glass opacities in both lungs, more pronounced in the lower lobes, and interlobular septal thickening, suggesting potential mild interstitial pneumonia changes. The old subpleural lesions in the lower lobe remained unchanged. (C) Absolute EOS and temperature fluctuations were consistent and responsive to glucocorticoid therapy. Methylprednisolone was administered during hospitalization as the patient's temperature, cough, and shortness of breath had worsened, and blood eosinophil levels had increased on two separate occasions.
case_images: fimmu-14-1277734-g002.jpg
case_images: PMC10801202_01_fimmu-14-1277734-g002.jpg
case_images: f2
case_images: During hospitalization, blood gas analysis showed a pO2 of 75 mmHg, pCO2 of 45.7 mmHg, and HCO3- of 29.0 mmol/L, and lung computed tomography (CT) scans revealed interstitial pneumonia ( Figure 2 ). Several times during hospitalization, the patient's eosinophils (EOS) became elevated (up to 1,600 cells/mul) in parallel with increased body temperature and shortness of breath ( Figure 2 ).