Benjamin L. Robinson, DO, Byung S. Yoo, MD, Nilesh I. Lodhia, MD Atrium Health, Charlotte, NC
Introduction: Alopecia areata (AA) is increasingly recognized as an extraintestinal manifestation of Crohn's disease (CD), with its prevalence among individuals with inflammatory bowel disease (IBD) exceeding that of the general population. This heightened prevalence underscores a shared pathophysiology, notably a common autoimmune, T-cell-mediated pathway via the Janus Kinase/signal transducers and activators of transcription (JAK/STAT) signaling axis. Inhibitors targeting the JAK pathway have demonstrated efficacy in treating AA and are progressively being adopted in CD management. We describe a clinically challenging case of concomitant AA and Crohn's ileitis, which showed a remarkable response to treatment with upadacitinib, underscoring its potential as a therapeutic option in similar cases.
Case Description/Methods: A 23-year-old male with a medical history of neonatal ileal atresia necessitating ileocecectomy presented with chronic diarrhea. Colonoscopy revealed a normal colon but identified multiple ulcerations in the neo-terminal ileum. Histologically, these lesions showed chronic active ileitis, leading to a diagnosis of CD. Notably, the patient also had a history of AA, which began at age 16 and progressed to alopecia universalis despite conventional therapies. Given the concurrent presence of Crohn's ileitis and alopecia universalis, treatment with the Janus kinase 1 (JAK1) inhibitor upadacitinib was initiated at a dosage of 45 mg daily for 12 weeks, followed by a maintenance dose of 30 mg daily. Within a month of treatment initiation, hair regrowth was observed on the patient's scalp, eyebrows, and eyelashes. This clinical improvement was sustained over subsequent months (Figure 1). Additionally, his CD symptoms ameliorated, and the ulcerations in the terminal ileum showed signs of healing on follow-up colonoscopy.
Discussion: The sparse number of case reports on JAK1 inhibitors used to treat concurrent CD and AA emphasizes the uniqueness of our case. A significant correlation between AA and CD holds clinical relevance, suggesting the necessity of screening patients with AA for IBD symptoms. Furthermore, there are reports of alopecia occurring after CD treatment with TNF-α inhibitors. JAK1 inhibitors have also been found to improve TNF-α-induced alopecia, suggesting further utility of this medication class. In conclusion, our case highlights the significance of upadacitinib as a viable therapeutic option for managing the complex interplay between alopecia areata and Crohn's disease.
Figure: Figure 1. Absence of hair on scalp, eyebrows, and eye lashes prior to initiating upadacitinib (A). Hair regrowth after 8 months of upadacitinib (B, C).
Disclosures:
Benjamin Robinson indicated no relevant financial relationships.
Byung Yoo indicated no relevant financial relationships.
Nilesh Lodhia indicated no relevant financial relationships.
Benjamin L. Robinson, DO, Byung S. Yoo, MD, Nilesh I. Lodhia, MD. P2696 - Concurrent Management of Crohn's Ileitis and Alopecia Universalis With Upadacitinib, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
