A rare combination of type 3 autoimmune polyendocrine syndrome (APS-3) or multiple autoimmune syndrome (MAS-3)

Abstract

ContextType 3 autoimmune polyendocrine syndrome (APS-3) is defined by the presence of an autoimmune thyroid disease and another autoimmune illness, excluding Addison’s disease; this is a frequent combination.Case presentationWe report the case of a 55 years old female patient with APS-3, with seven clinical or latent autoimmune manifestations. At 49 years of age she was admitted at the General Hospital for leukopenia, weight loss, tremors, anxiety and diarrhea. The personal history revealed ulcerative colitis and, during the last year, episodes of fever with migrant arthralgia and cutaneous lesions. The patient was evaluated for thyroid function and imaging, mielobiopsy, glycaemic control, gastrointestinal and rheumatologic disorders with specific biochemical tests, imaging and endoscopic procedures. We concluded that the patient was affected by APS-3, characterized by the association of Graves’ disease, autoimmune leukopenia, latent autoimmune diabetes of the adult (LADA), autoimmune gastritis, ulcerative colitis, Sjögren’s and anti-phospholipid syndromes. The patient started low doses of corticosteroid drugs for leukopenia, underwent 131I therapy for hyperthyroidism and later started substitutive thyroid therapy with l-thyroxine, insulin therapy for LADA, mesalazine for ulcerative colitis and artificial tears for Sjögren’s syndrome.ConclusionsIn this article we report a complex case of APS-3, characterized by the association of seven different autoimmune diseases, which required a complex therapeutic strategy.

Venlafaxine Er-Related Strong Suicidal Intent in an Adult With Lithium-Treated Severe Major Depression: A Phenomenological Proximity With Other Paradoxical Reactions of Psychoactive Agents

“…A 45-year-old white male with normal BMI was admitted due to a severe relapse of a recurring MDD, which occurred under lithium (serum level: 0.82 mM) and 45 mg mirtazapine, both taken at bedtime, together with frequent medical/psychiatric counselling & psycho-education as well as long-term psychotherapy. Comorbid alcohol use disorder and social phobia were in remission in contrast to an active autoimmune polyglandular syndrome (APS) subtype 4 with vitiligo acrofacialis, Hashimoto thyroiditis and lymphocytic colitis (Betterle et al 2014). Beyond this, the physical examination was unremarkable.…”

“…Routine lab revealed an increased thyroid-stimulating hormone (TSH 25 mU/L) despite thyroid-hormone-replacement therapy with 200µg/day L-thyroxine and a slightly increased CRP. The remaining lab was normal including vitamin B serum-levels and autoimmune diagnostics even with respect to Addison´s disease and diabetes mellitus (Betterle et al 2014). Upon admission, the patient was severely depressed (Hamilton Depression Score; HAM-D21item 39 points) with dominant loss of energy, social withdrawal, loss of appetite, great lacks of drive and motivation, feeling of worthlessness, great difficulty to concentrate, diffuse anxious agitation, high stress vulnerability, insomnia and chronic suicidal ideation (APA 2003).…”

Type 3 autoimmune polyendocrine syndrome (APS) diagnosed in an 87-year-old patient with a concomitant chronic autoimmune urticaria

“…Autoimmunologiczne zespoły niedoczynności wielogruczołowej (autoimmune polyendocrine syndromes -APSs) to heterogenna grupa schorzeń charakteryzujących się dysfunkcją nie tylko gruczołów dokrewnych, lecz także innych narządów [1][2][3][4][5][6]. Aktualna klasyfikacja APS oparta na zróżnicowanym obrazie klinicznym została sformułowana przez Neufelda i wsp.…”

“…Autoimmune polyendocrine syndromes (APSs) are a heterogeneous group of diseases characterized by dysfunctions of not only incretory glands, but also other organs [1][2][3][4][5][6]. Current APS classification based on diverse clinical picture was formulated by Neufeld et al [7] (table 1).…”

Preliminary study of Autoimmune Polyglandular Syndrome (APS). Are they solely an endocrinological problem?

“…For example, the coexistence of addison's disease with one or more of the diseases, other than the main aPs 1, 2 and 3 components (excluding candidiasis, hypoparathyroidism, autoimmune thyroid disease and type 1 diabetes), allows for the diagnosis of aPs-4 [9][10][11].…”