PMC9549181_01
Multiple typical MS lesions are shown in the cerebral hemispheres on
FLAIR-images [(a) sagittal] and 2 gadolinium-enhancing lesions at
T1-weighted images post-contrast [arrows (b) axial]; MRI was acquired before
alemtuzumab initiation. Alopecia at onset (month 8) with hair loss in the
form of patches (c); month 14 (d) after alopecia universalis diagnosis;
month 20 (e) after the first alemtuzumab course when only partial recovery
of hair loss was noted. Anterior segment OCT of the right eye, at the onset
of blurred distance vision (third day of the second alemtuzumab-cycle),
reveals a narrow iridocorneal angle [(f)-i]; 2 days later, deepening of the
angle is observed with reduction of iris convexity [(f)-ii]; resolution of
angle closure 5 days following the initial event with horizontal iris, no
iridocorneal apposition, or anterior lens vault [(f)-iii].. FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging;
MS, multiple sclerosis; OCT, optical coherence tomography.
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PMC9549181_01_10.1177_17562864221127476-fig1.jpg
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However, 4 months later he relapsed again with 4 gadolinium-enhancing lesions on brain MRI [Figure 1(a) and (b)] and received IVMP again. Eight months later, he complained of gradual loss of head hair, initially in the form of patches [Figure 1(c)], and then gradual loss of body hair was noted. Hair loss was exacerbated and 3 months later a complete loss of all scalp and body hair and an almost complete loss of the eyebrows and eyelashes were observed; these findings were consistent with alopecia universalis which persisted even 14 months after the first alemtuzumab-cycle [Figure 1(d)]. Anterior segment optical coherence tomography (OCT) confirmed the anterior displacement of iris [Figure 1(f)-i]. Anterior chamber depth was measured 2.88 mm OD and 2.95 mm OS with mild deepening of the angle [Figure 1(f)-ii]. Slit-lamp examination revealed deepening of the anterior chambers, which were measured 3.48 mm OD and 3.56 mm OS, with normalization of corneal angle [Figure 1(f)-iii]. At the last follow-up 6 months after the second course, there was a partial hair regrowth [Figure 1(e)], the ophthalmologic examination had no abnormal findings and there was complete resolution of symptoms for distance, and the EDSS score was 1.