Kidney Week

Abstract: FR-PO475

Effect of Dupilumab in Treating Refractory Allergic Dermatitis to Peritoneal Dialysis Catheter: A Case Report

Session Information

• Home Dialysis - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Takeoka, Jun, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Jun Takeoka, MD

• Toda, Naohiro, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Naohiro Toda, MD, PhD

• Sato, Ryo, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Ryo Sato

• Fujita, Kyoka, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Kyoka Fujita

• Kurahashi, Satoshi, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Satoshi Kurahashi, MD

• Hirashima, Hisako, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Hisako Hirashima, APN

• Muso, Eri, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Eri Muso, MD, PhD

• Komiya, Toshiyuki, Otsu Sekijuji Byoin Toshoshitsu, Otsu, Shiga, Japan

Toshiyuki Komiya, MD, PhD

• Ishii, Akira, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Akira Ishii, MD, PhD, DrPH

Introduction

Eosinophilia during induction of peritoneal dialysis (PD) is frequently caused by icodextrin, but allergic reactions to PD catheters has been rarely reported. We report a case of refractory systemic contact dermatitis associated with a PD catheter that was successfully treated with dupilumab, avoiding catheter removal.

Case Description

A 62-year-old man underwent PD catheter implantation by Moncrief-Popovich technique due to progression of diabetic kidney disease five months before admission. One month later, he developed generalized pruritus and his eosinophils were elevated to 2500/μL. Topical steroids and antihistamines were started, but itching did not get better and eosinophil count remained high. One month before admission, he started PD. The itching became unbearably intense, and the patient was hospitalized because of erythema and desquamation on whole body. Eosinophilic peritonitis and reactivation of human herpes virus 6 (HHV6) were not observed. He was started on PSL (10mg daily), but his eosinophil count remained around 2000/μL and his skin rash did not improve. Drug-induced lymphocyte stimulation test (DLST) was negative for several drug and positive for PD catheter. Systemic contact dermatitis caused by the PD catheter was diagnosed from the DLST result. After the PSL dose was increased to 40 mg daily for refractory systemic contact dermatitis with liver damage, the eosinophil count and skin rash improved. Administration of dupilumab allowed PSL withdrawal and maintained skin status and eosinophil count.

Discussion

As the patient had type 2 diabetes mellitus, long-term oral administration of PSL should be avoided from the viewpoint of glucose tolerance and susceptibility to infection. Dupilumab is an IL4/IL13 receptor monoclonal antibody and is used for refractory atopic dermatitis, but there are no reports of dupilumab use for allergic dermatitis caused by PD catheters. In this case, the use of dupilumab allowed PD continuation without eosinophil elevation or flare-ups of skin rash even after gradual PSL reduction.