Abstract: We report a case of dupilumab-induced immune drifting from atopic dermatitis to polymyalgia rheumatica. A 66-year-old female presented with bilateral shoulder pain, widespread myalgia and morning stiffness for 4 weeks. She has had a history of moderate-to-severe atopic dermatitis and was treated with dupilumab over the past 48 weeks. Physical examination revealed limitation of active shoulder, hip and knee abduction but the muscle strength was normal. Laboratory findings showed elevated levels of erythrocyte sedimentation rate, C-reactive protein, while creatine kinase, rheumatoid factor and anti-cyclic peptide containing citrulline were of normal value. The patient was treated with low dose of prednisone, methotrexate, and other supportive treatment and the myalgias, rash and pruritus improved.

Key words: polymyalgia rheumatica, atopic dermatitis, dupilumab, immune drifting