Immune checkpoint blockades have been widely used to treat various
malignancies.
Programmed cell death protein 1 (PD-1) inhibitor-induced
alopecia areata, one of the immune-related adverse events, is rarely reported. We present a case of
alopecia universalis during the treatment of
Sintilimab, a monoclonal anti-PD-1 antibody, in a patient with
hepatocellular carcinoma. A 65-year-old male was diagnosed with
hepatocellular carcinoma in liver segment VI (S6) and chose to receive
Sintilimab due to predicted insufficient residual liver volume for
hepatectomy. He presented extensive
hair loss in all the parts of the body 4 weeks after
Sintilimab treatment. And without using any dermatologic drug, the
alopecia areata gradually developed to be
alopecia universalis after
Sintilimab continuous treatment for 21 months. The pathological examination of skin revealed remarkable increased lymphocytes infiltration around the hair follicles, which contained predominantly CD8 positive T cells in the dermis. During single
immunotherapy, the
tumor marker of serum
alpha-fetoprotein level soon decreased from 512.1 mg/L to a normal level within 3 months, accompanied with a remarkable
tumor regression in liver S6 by magnetic resonance imaging scans. The patient received
hepatectomy and pathological examination demonstrated the nodule was full of extensive
necrosis. By combining
immunotherapy and
hepatectomy, the patient finally achieved a remarkable anti-
tumor effect of complete remission. Immune checkpoint blockades-induced
alopecia areata is a rare immune-related adverse event and accompanied with a good anti-
tumor efficacy in our case. Regardless of
alopecia treatment,
PD-1 inhibitor treatment is recommended to be continued, especially when the
immunotherapy is effective.