S4245 Severe EOE Flaring Asthma Exacerbation: A Case Report of Type-2 Inflammatory Diseases in a 20-Year-Old Man, Characterized by Eosinophilic Infiltration: Successful Management With Dupilumab

Introduction: Eosinophilic esophagitis (EoE) is an immune-mediated disease that can coexist with atopic conditions, including asthma and gastroesophageal reflux disease (GERD). GERD-related acid reflux can worsen asthma, and EoE may further complicate asthma management. dupilumab, an IL-4/IL-13 inhibitor, has shown efficacy in managing both conditions. Case Description/Methods: A 20-year-old man with a history of moderate persistent asthma, recurrent exacerbations, and ongoing GERD symptoms arrived at the emergency department complaining of acute shortness of breath, chest tightness, and severe wheezing. Despite regular treatment with inhaled corticosteroids and long-acting beta-agonists, he had experienced frequent asthma attacks over the past year, some severe enough to require intubation. During this visit, he also reported persistent GERD symptoms, such as heartburn and difficulty swallowing. An esophagogastroduodenoscopy with biopsy showed significant eosinophilic infiltration, leading to a diagnosis of EoE. Treatment with topical budesonide and continued proton pump inhibitors improved his asthma control. However, due to lingering symptoms, dupilumab—a therapy targeting interleukin-4 and interleukin-13—was added, further alleviating both his asthma and GERD symptoms without any subsequent exacerbations. Discussion: This case emphasizes the need to consider EoE in patients with difficult asthma and GERD. The use of dupilumab, which targets eosinophilic inflammation, successfully managed both conditions and enhanced the patient's quality of life, highlighting the effectiveness of biologic therapies in complex cases.