{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T18:55:13Z","timestamp":1783191313627,"version":"3.54.6"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T00:00:00Z","timestamp":1655683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Dupilumab is a new monoclonal antibody inhibiting IL-4 and IL-13 signaling transduction through the blockage of the \u03b1-subunit of the IL-4 receptor. It is used to treat type 2 inflammatory disorders including atopic dermatitis, asthma, and chronic rhinosinusitis. Here we describe the case of a 79-year-old male presenting with visual hallucinations, disorientation, cognitive decline, and behavioral changes, evolving over 3 weeks. He had been under treatment with dupilumab for atopic dermatitis for the previous 4 months. Radiology and CSF analysis showed a granulomatous meningoencephalitis suspicious of sarcoidosis. Underlying infectious and antibody-mediated causes for meningoencephalitis were ruled out. Pausing Dupilumab and steroids (i.v. and oral) led to rapid clinical improvement. Inhibition of IL-4 and IL-13, key players in the differentiation and activation of Th2 cells, may shift the Th1\/Th2- ratio toward an excessive Th1-mediated response, granuloma formation, and drug-induced (neuro)sarcoidosis reaction. Attention should be raised to this side effect.<\/jats:p>","DOI":"10.3389\/fneur.2022.881144","type":"journal-article","created":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T12:37:53Z","timestamp":1655728673000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Case Report: Drug-Induced (Neuro) Sarcoidosis-Like Lesion Under IL4 Receptor Blockade With Dupilumab"],"prefix":"10.3389","volume":"13","author":[{"given":"Stergios","family":"Tsitos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Catherina","family":"Niederauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Albert i Gracenea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Straube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Von Baumgarten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.2147\/TCRM.S125964","article-title":"Dupilumab in the management of moderate-to-severe asthma: the data so far","volume":"13","author":"Barranco","year":"2017","journal-title":"Ther Clin Risk Manag."},{"key":"B2","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.alit.2020.01.002","article-title":"Dupilumab: basic aspects and applications to allergic diseases","volume":"69","author":"Matsunaga","year":"2020","journal-title":"Allergol Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.1016\/S0140-6736(19)31881-1","article-title":"Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomized, double-blind, placebo-controlled, parallel-group phase 3 trials","volume":"394","author":"Bachert","year":"2019","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s00408-015-9826-3","article-title":"Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: a population-based study","volume":"194","author":"Ungprasert","year":"2016","journal-title":"Lung."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.1111\/jdv.16218","article-title":"Drug-induced granulomatosis: is dupilumab the new kid on the block?","volume":"34","author":"Belhomme","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.chest.2018.03.056","article-title":"Drug-induced sarcoidosis-like reactions","volume":"154","author":"Chopra","year":"2018","journal-title":"Chest."},{"key":"B7","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/joim.13008","article-title":"The epidemic of drug-induced sarcoidosis-like reactions: a side effect that we can live with","volume":"288","author":"Judson","year":"2019","journal-title":"J Intern Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1378\/chest.119.3.978","article-title":"Recurrent pulmonary sarcoidosis in HIV-infected patients receiving highly active antiretroviral therapy","volume":"119","author":"Lenner","year":"2001","journal-title":"Chest."},{"key":"B9","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1089\/cbr.2010.0865","article-title":"Releasing the brake on the immune system: ipilimumab in melanoma and other tumors","volume":"25","author":"Tarhini","year":"2010","journal-title":"Cancer Biother Radiopharm."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1002\/cncr.24951","article-title":"Single-institution experience with ipilimumab in advanced melanoma patients in the compassionate use setting: lymphocyte count after 2 doses correlates with survival","volume":"116","author":"Ku","year":"2010","journal-title":"Cancer."},{"key":"B11","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1136\/ard.62.6.561","article-title":"Sieper J. 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Treatment with monoclonal anti-tumor necrosis factor alpha antibody results in an accumulation of Th1 CD4+ T cells in the peripheral blood of patients with rheumatoid arthritis","volume":"42","author":"Maurice","year":"1999","journal-title":"Arthritis Rheum."},{"key":"B13","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/01.mcp.0000134400.88832.9c","article-title":"Interferon-induced granulomatous lung disease","volume":"10","author":"Marzouk","year":"2004","journal-title":"Curr Opin Pulm Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1868","DOI":"10.1111\/j.1365-2222.2004.02124.x","article-title":"Identification of anti-inflammatory drugs according to their capacity to suppress type-1 and type-2 T cell profiles","volume":"34","author":"Moed","year":"2004","journal-title":"Clin Exp Allergy"},{"key":"B15","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/978-94-017-9487-9_2","article-title":"Th1\/Th2 cell differentiation and molecular signals","volume":"841","author":"Zhang","year":"2014","journal-title":"Adv Exp Med Biol."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.881144\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T12:37:55Z","timestamp":1655728675000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.881144\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,20]]},"references-count":15,"alternative-id":["10.3389\/fneur.2022.881144"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.881144","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,20]]},"article-number":"881144"}}