A Case of Polyautoimmunity: Celiac Hepatitis, Grave's Disease and Autoimmune Hemolytic Anemia

Abstract

A 19-year female, diagnosed case of CD for eight years and GD for five years, presented at the Emergency Department with history of persistent jaundice for two months. There was also history of chronic diarrhea, fatigue and shortness of breath on exertion. She was receiving carbimazole, 10 mg, BID, and was admittedly non-compliant to both a gluten-free diet (GFD) and the medications. She had completely stopped taking the medications for six weeks at the time of presentation. On examination, the patient was hemodynamically stable, jaundiced and anemic. She had thin coarse hair, fine tremor, exophthalmos (Figure 1), a positive lid lag, Von Graefe's and lid retraction signs. Fluid thrill and shifting dullness were also present. There were also patches of hypo-pigmented skin in the hands, forearms and legs, consistent with vitiligo. Initial laboratory tests showed hemoglobin (Hb) of 8.8 g/dL, mean corpuscular volume (MCV), 85.5 fL, platelets, 68 x109/L, and white blood cell count (WBC) of 9.2 x109/L.

Celiac Disease With Autoimmune Hemolytic Anemia and Autoimmune Hepatitis in a Young Child: Case Report and Literature Review

“… 23 However, the association of AIHA with autoimmune hepatitis is a distinct condition rarely reported in children. 24 Literature supports the fact that it needs aggressive therapy with immunosuppression with steroids and Azathioprine. 25 Literature shows that patient respond well to treatment with resolution of symptoms as seen in our case.…”

Ocular Cicatricial Pemphigoid, Sjögren’s Syndrome, and Hashimoto’s Thyroiditis as a Multiple Autoimmune Syndrome: A case report

“…12 Similarly, immunogenic factors, such as HLA-DQB1*0301, LRP1/STAT6, AIRE, and physiopathological mechanisms shared by ADS could determine biologic and nonbiologic drugs usefulness in MAS management. 7,12 Butt et al 13 suggested treating each AD separately, taking into account the clinical condition and individual aspects of each patient. On account of OCP progression and the risk of visual loss in our patient, treatment was based in a stepladder combined therapy.…”

Anemia and diseases of the gastrointestinal tract

“…Различают первичные АИГА и вторичные АИГА, возникшие на фоне инфекций, аутоиммунных и онкологических процессов [24]. Описаны АИГА при кишечных инфекциях, аутоиммунных заболеваниях ЖКТ (целиакия, первичный билиарный холангит) [25,26,27], онкологической патологии пищеварительной системы (карциноиды, аденокарциномы) [28,29]. Развитие АИГА чаще опосредованно тепловыми антителами к эритроцитам, как правило, IgG 1 и IgG 3 типов, реже холодовыми антителами (IgM) [30].…”