The Role of Dupilumab in Atopic Dermatitis-Like Graft-Versus-Host Disease

Atopic dermatitis-like graft-versus-host disease (AD-like GVHD) is a rare but challenging complication following hematopoietic stem cell transplantation (HSCT), mimicking features of atopic dermatitis (AD) and often requiring prolonged immunosuppression. We report the case of a 14-year-old girl with a history of mild AD and post-HSCT GVHD involving skin and the gastrointestinal tract, presenting with severe pruritus, extensive eczema, and significant impact on quality of life. Standard treatment with corticosteroids and immunosuppressants yielded suboptimal results and notable side effects, including growth retardation. After multidisciplinary evaluation, off-label treatment with dupilumab was initiated, resulting in significant clinical improvement, corticosteroid tapering, and enhanced quality of life. This case highlights the potential role of dupilumab as a safe and effective corticosteroid-sparing therapy for AD-like GVHD in pediatric patients, although further studies are needed to confirm its long-term safety and efficacy in transplant settings.