Endocrine Abstracts

Introduction: Haematologic involvement is not uncommon in Graves’ disease. Autoimmune haemolytic anaemia is occasionally reported in patients with other autoimmune illnesses. However very rarely reported in Graves’ disease.

Case report: We report a 19-year-old female with reactive arthritis, Graves’ disease and autoimmune haemolytic anaemia while under treatment with methimazole. Physical examination: Under built female BMI 17, Blood pressure was 110/70, heart rate 100 min., respiratory rate 16 min, temperature 37.6, jaundice, pallor, no cervical, supraclavicular, epitrochlear, axillary, or inguinal lymphadenopathy. The thyroid gland mildly enlarged not nodular no thrill or bruit, proptosis, no lid-lag, or tremor. Lungs were clear and the heart rhythm was regular, accentuated S1, pulmonary component of S2 ejection systolic murmur over the cardiac base no click, or gallop. The abdomen was soft and non-tender, with the liver edge not palpable; the spleen was palpable 3 cm below LF costal margin, joint pain affecting both knees with limitation of movement.

Investigations: Haemoglobin 4.4 g/dl, MCV 107.2, platelet count 193 000, WBC count 4 000, reticulocyte count 23.3%, Bilirubin 4.0 mg/dl (direct 0.4), LDH 311 U/l, positive comb test, ESR;128, ANA negative. Abdominal sonar mild splenomegaly, normal echo cardiography. The patient was started on prednisone 1 mg/kg with rapid improvement in her anaemia and jaundice. 11 days after admission haemoglobin improved to 10.0 g/dl. The prednisone was tapered off over 3 months with continued stable haemoglobin levels and no evidence of recurrent haemolysis.

Conclusion: We report a case of concurrent reactive arthritis, Graves’ disease, and autoimmune haemolytic anaemia. Yersinia enterocolitica infection could theoretically cause both reactive arthritis and Graves’ disease, although we cannot prove this connection in our patient’s case which improved dramatically on steroids.