PMC8687844_01
Timeline of development of autoantibodies (a), autoimmune processes (b), and smooth muscle and SSA antibodies (c) with time course of known immunosuppressive therapy also shown.
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AIRE gene variants, additional serologic testing revealed seropositivity for 21-hydroxylase antibodies (a marker for adrenal autoimmunity) and positivity for intrinsic factor autoantibodies (a marker for atrophic gastritis).  Figure 1(a) shows her positive serology over time, along with her immunosuppressive medications. Antibody testing for thyroid disease, type 1 diabetes mellitus, and celiac disease yielded negative results at that time. Subsequently, hydrocortisone and fludrocortisone replacement therapy were initiated.  Figure 1(b) shows the number of autoimmune conditions over time along with her immunosuppressive medications. Over time, her smooth muscle antibodies and SSA antibody levels have gradually normalized (Figure 1(c)).
Progression of alopecia: early stages of disease (a), progression of disease (b), improvement in alopecia (c).
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Complete hair regrowth was achieved within a year.  Figure 2 denotes progressive hair loss (2(a) and 2(b)) followed by hair regrowth (2(c)).