Multiple autoimmune syndrome: about six observations

Soumaya Mrabet; Aya Hammami; Elleuch Nour; Jaziri Hanen; Ben Slama Aida; Braham Ahlem; Ajmi Salem; Mehdi Ksiaa; Jmaa Ali; Ben Jazia Elhem

doi:10.1530/endoabs.49.EP762

Introduction: Autoimmune disorders are known to be more frequent in women and often associated each others, but it is rare to see multiple autoimmune diseases in a single patient. Multiple autoimmune syndrome (MAS) is defined as the combination of at least three autoimmune diseases in the same patient. The pathogenesis of MAS is not known. Genetic, infectious, immunologic and psychological factors have all been implicated in its development.

Observations: We report six new observations of MAS.

Results: Observation 1: A 24-year-old female patient followed for Hashimoto’s thyroiditis, Addison disease and celiac disease. The patient was explored for cytolysis. The diagnosis of autoimmune hepatitis was retained and the patient was treated with oral corticosteroid and azathioprine. Observation 2: A 61-year-old woman without special history who was diagnosed to have autoimmune hepatitis, celiac disease, autoimmune pancreatitis and sclerosing cholangitis. The patient was put on a gluten-free diet, corticosteroid therapy, azathioprine and ursodeoxycholic acid. Observation 3: A 37-year-old man, with a history of vitiligo and Hashimoto’s thyroiditis, presented asthenia and normocytic normochromic anemia. Biermer’s disease and celiac disease have been diagnosed. Observation 4: A 41-year-old woman with a history of Hashimoto thyroiditis presented a dry syndrome and asthenia and liver cytolysis. The anti-nuclear, anti-SSA and anti-SSB antibodies were positive and labial biopsy showed a lymphocytic sialadenitis stage III of Chisholm confirming the association autoimmune hepatitis and syndrome of Gougerot Sjogren. Observation 5: A 29-year-old female patient with a history of Type 1 diabetes, Basedow and Addison diseases was diagnosed to have a celiac disease revealed by diarrhea and abdominal pain. Observation 6: A 31-year-old woman follwed for Systemic erythematosus lupus and Gougerot Sjogren syndrome presented a persistent anemia. Anti-transglutaminase antibodies were positive and duodenal biopsies showed subtotal villous atrophy confirming celiac disease.

Conclusion: Patients with autoimmune diseases have a tendency to develop additional autoimmune disorders indicating the need for continued surveillance for the development of new autoimmune disease in predisposed patients.

Endocrine Abstracts

EP762