A case of mixed connective tissue disease complicated with thymic carcinoma and Hashimoto's thyroiditis

Mixed connective tissue disease (MCTD) is a systemic autoimmune disease with features overlapping multiple autoimmune disorders. One study found that over 55% of patients with MCTD experienced neuropsychiatric symptoms, the most common of which was an “aseptic meningitis-like syndrome.” We present a case of a 17-year-old adolescent girl presenting with abnormal speech and behavior, auditory hallucinations, and paranoid delusions after an isolated episode of fever. She was treated for her psychotic symptoms but later developed symptoms resembling neuroleptic malignant syndrome. An antibody screen revealed elevated anti-U1-ribonucleoprotein antibodies with a possible diagnosis of MCTD. She finally responded to steroid therapy. To our knowledge, this is the first reported case of MCTD initially presenting with psychosis. A diagnosis of autoimmune disorders should be kept in the differential of similar clinical presentations including connective tissue disorders and autoimmune thyroid conditions.

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Mixed Connective Tissue Disease and Papillary Thyroid Cancer: A Case Report

Thongpooswan

Tushabe

Song

et al. 2015

Am J Case Rep

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Patient: Female, 58Final Diagnosis: Papillary thyroid carcinomaSymptoms: Cough • shorthness of breathMedication: —Clinical Procedure: Fine needle aspiration and a near total thyroidectomySpecialty: RheumatologyObjective:Rare co-existance of disease or pathologyBackground:Mixed connective tissue disease (MCTD) is a connective tissue disorder characterized by high titers of distinct antibodies: U1 ribonucleoprotein with clinical features seen in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM), polymyositis, and scleroderma. The association of SLE and DM with various cancers of the thyroid has been reported in the literature. However, there have been no reports associating MCTD with thyroid cancer.Case Report:We present a 58-year-old woman diagnosed with MCTD with co-morbid interstitial lung disease that has remained stable for 10 years, who developed papillary thyroid carcinoma (PTC) 10 years after initial diagnosis.Conclusions:We theorize that: 1) MCTD may have been a primary diagnosis complicated by PTC, or 2) MCTD may have been an initial presentation of paraneoplastic syndrome of silent PTC, because her symptoms of MCTD significantly improved after total thyroidectomy. To the best of our knowledge, this is the first case report to associate MCTD with PTC. It highlights the importance of maintaining a high index of suspicion for thyroid malignancy in MCTD patients.

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A case of mixed connective tissue disease complicated with thymic carcinoma and Hashimoto's thyroiditis

Cited by 4 publications

References 9 publications

Idiopathic connective tissue disorders

Idiopathic connective tissue disorders

Mixed Connective Tissue Disease Presenting With Psychosis—A Case Report

Mixed Connective Tissue Disease and Papillary Thyroid Cancer: A Case Report

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