Association between three autoimmune diseases: vitiligo, primary biliary cirrhosis, and Sjögren's syndrome

Abstract

Although the association of multiple autoimmune diseases has already been widely described, no reports of the association between vitiligo, primary biliary cirrhosis and Sjogren's syndrome were retrieved in the SciELO and PubMed databases. The authors describe the case of a female patient who was diagnosed with primary biliary cirrhosis and Sjogren's syndrome at age 54. At age 58, she developed vitiligo restricted to the face, associated with significant impairment of self-esteem and quality of life. Antinuclear antibody was negative at the onset of the condition, but became positive after phototherapy initiation. In general, the occurrence of multiple autoimmune diseases in the same patient is known as a mosaic of autoimmunity. However, specific mechanisms appear to interconnect primary biliary cirrhosis and Sjogren's syndrome, such as PDC-E2-mediated generalized epithelitis.

Vitiligo as the Presenting Manifestation of Sjogren’s Syndrome: Case Report and Review of Vitiligo and Its Associated Autoimmune Conditions

“…It primarily affects lacrimal and salivary glands. Most patients present with dry eyes and/or dry mouth [ 2 , 11 , 12 ].…”

“…Skin manifestations associated with Sjogren’s syndrome are uncommon and are often under-reported. Cutaneous features of Sjogren’s syndrome include alopecia, purpura, urticaria-like vasculitis, vitiligo, and xerosis [ 2 , 12 ].…”

“…Sjogren’s syndrome is a chronic inflammatory autoimmune condition characterized by key features such a dry mouth (xerostomia) and dry eyes (xerophthalmia) [ 2 ]. Laboratory findings include a positive antinuclear antibody (ANA) titer as well as antibodies to Sjogren’s syndrome A (SS-A/Ro) and/or Sjogren’s syndrome B (SS-B/La) [ 3 ].…”

“…Laboratory findings include a positive antinuclear antibody (ANA) titer as well as antibodies to Sjogren’s syndrome A (SS-A/Ro) and/or Sjogren’s syndrome B (SS-B/La) [ 3 ]. Cutaneous manifestations of Sjogren’s syndrome are infrequent; however, in addition to vitiligo, they may include alopecia, dryness of the skin, purpura, and vasculitis presenting morphologically similar to urticaria [ 2 , 4 ].…”

Discovery of microRNA expression profiles involved in regulating TGF-β2 expression in the tears of dry eye patients

“…1 At present, it is believed that autoimmune diseases, hormone deficiency, dry air, environment, age and other factors form a comprehensive cause of dry eye syndrome. 2,3 An important manifestation of dry eye is that the amount of water, lipid and mucin secreted on the surface of the eyeball is reduced, breaking the balance between the quality and quantity of tear fluid, which causes eye discomfort. 4 The concentration of transforming growth factor beta2 (TGF-β2) in tears can be used as an index to evaluate the amount of tears and can judge the tear secretion function to a certain extent.…”