# Acute Severe Immune Thrombocytopenia Following Dupilumab Use for Eustachian Tube Dysfunction: A Case Report

## TL;DR

A 76-year-old man developed severe immune thrombocytopenia after using dupilumab for eustachian tube dysfunction, highlighting a rare but serious side effect.

## Contribution

This case report highlights dupilumab as a potential cause of immune thrombocytopenia, a rare adverse event not previously well-documented.

## Key findings

- A 76-year-old male developed acute severe thrombocytopenia two weeks after starting dupilumab.
- Treatment with corticosteroids and intravenous immunoglobulin led to rapid platelet recovery.
- The case supports a diagnosis of dupilumab-induced immune thrombocytopenia after excluding other causes.

## Abstract

Immune thrombocytopenic purpura (ITP) is a rare hematologic disorder characterized by isolated thrombocytopenia and mucocutaneous bleeding. While drug-induced ITP (DITP) is recognized with certain medications, reports associated with dupilumab, a monoclonal antibody used for atopic dermatitis and other inflammatory conditions, are exceedingly rare. We present a case of acute, severe thrombocytopenia occurring two weeks after dupilumab initiation for eustachian tube dysfunction in a 76-year-old male. Comprehensive evaluation excluded secondary causes, supporting a diagnosis of dupilumab-induced ITP. Treatment with corticosteroids and intravenous immunoglobulin led to rapid platelet recovery. Given the expanding use of dupilumab, awareness of this rare but potentially serious adverse event is crucial. Clinicians should remain vigilant for mucocutaneous bleeding in patients receiving biologic agents and initiate appropriate treatment promptly. Moreover, enhanced pharmacovigilance and further research are needed to elucidate the incidence, risk factors, and mechanisms of dupilumab-associated hematologic toxicity.