Dupilumab And Its Growing Pains

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Dupilumab And Its Growing Pains - Page #1

Author: Raymond Zhou, MD Senior Editor: Justin Mark Young, MD Editor: Irvin Sulapas, MD Patient Presentation: A 32-year-old male presented to the Sports Medicine clinic with 6 months of progressively worsening, intermittent left shoulder pain radiating into the axilla. History: He participates in cardio and resistance training for fitness, and finds the pain is reproduced during repetitive activity with the shoulder in overhead positions. The pain is unrelated to increased resistance or weight bearing. Sleeping on his stomach exacerbates the symptoms, waking him up every 2 nights. His symptoms resolve when shaking out the left arm. His past medical history includes asthma and eczema, currently in remission and treated successfully with dupilumab for over 4 years. Dupilumab (better known as Dupixent) is a monoclonal antibody that binds to and antagonizes interleukin-4 receptors to block inflammatory signals. He also has a history of joint hypermobility without a formal diagnosis of connective tissue disease. His family history is notable for Hashimoto's thyroiditis in his father, but no other neurological, autoimmune, or rheumatologic diseases. Physical Exam: His physical exam was most notable for a positive Roos maneuver reproducing his pain. He had a palpable radial pulse and was maintained throughout the exam without color change. The patient demonstrated hypermobility with a Beighton score of 9. Hyperextension of the knees, elbows, thumb-to-forearm ranging, and pinky finger lifting to 90 degrees all indicated the patient's joint laxity. He had tenderness to palpation of the left upper trapezius, levator scapulae, medial scapular border, and AC joint. The rest of the exam was unremarkable. The patient was neurovascularly intact throughout the affected extremity and had no skin changes. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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