Upadacitinib for the Treatment of Systemic Immune Co-Morbidity in One Case: Alopecia Areata, Vitiligo, Ankylosing Spondylitis, and Allergic Rhinitis-Asthma – Multifaceted Control

Background: Immune-mediated inflammatory diseases (IMIDs) often coexist, but treatment options for multi-system comorbidities are limited. This report evaluated the efficacy and safety of the selective JAK1 inhibitor upadacitinib (UPA) in a patient with refractory alopecia areata (AA), vitiligo, ankylosing spondylitis (AS), and allergic asthma-nasal syndrome comorbidity. Case Presentation: A 52-year-old male patient, who had not responded to previous treatments including glucocorticoids, immunosuppressants, and biologics, received UPA (15 mg once daily) for 12 weeks. After treatment, all systemic symptoms significantly improved: the Severity of Alopecia Tool (SALT) score for AA decreased from 15 to 0.9, the vitiligo lesions re-colored and stabilized, spinal joint mobility increased, and the frequency of nasal and asthma attacks decreased. The serum total IgE level decreased from 295 ng/mL to 243 ng/mL. Conclusion: UPA achieved rapid and simultaneous improvements in this patient with refractory multi-system immune comorbidity. A transient liver function abnormality (ALT 478.6 U/L, AST 167 U/L) occurred during treatment, which was considered related to concomitant medication and resolved spontaneously after close monitoring and maintenance of the original regimen. This case suggests that UPA is effective for such complex comorbidities and has controllable safety under monitoring, providing a clinical basis for the “targeting upstream common pathways” strategy. Keywords: upadacitinib, JAK inhibitor, ankylosing spondylitis, vitiligo, alopecia areata, allergic rhinitis-asthma syndrome