Coeliac Disease Associated with Auto-Immune Thyroiditis, Sjogren's Syndrome, and a Lymphocytotoxic Serum Factor§

Abstract

Summary: This report describes a patient who presented with an exacerbation of coeliac disease symptoms, following initiation of treatment for an auto‐immune thyroiditis. She also had recently developed symptoms and signs of keratoconjunctivitis sicca and xerostomia. She was found to have a lymphocytotoxic serum factor having some but not all of the characteristics of an auto‐antibody and this factor completely prevented phytohaemagglutinin and allogeneic stimulation of her lymphocytes in vitro. Her serum contained multiple, thyroid‐specific, auto‐antibodies coexisting with a general lowering of the main immunoglobulin classes. Treatment with a gluten‐free diet produced improvement of both her coeliac and Sjogren's syndrome symptoms and signs and the lymphotoxic factor disappeared from her serum. The nature and significance of this factor is discussed, with particular emphasis upon relationship to lymphokines and to tumour incidence in coeliac disease.

The changing face of celiac disease

“…A Dutch study found a high frequency of CD of 7% in children with Down's syndrome (25). Other associations include Sjogren's syndrome (21), epilepsy (26), thyroiditis (27), hypertransaminasemia and chronic liver disease (28)(29)(30)(31)(32).…”

Coeliac disease and goitre

“…Thus coeliac disease has been reported in association with diabetes (Walker-Smith, Vines and Grigor, 1969), Sj6gren's syndrome (Maclaurin, Matthews and Kilpatrick, 1972;Pittman and Holub, 1965), thyroiditis (Maclaurin et al, 1972) and bird fancier's lung (Berrill et al, 1975). Two cases in which thyroid disease was associated with coeliac disease are now described.…”

The molecular basis of coeliac disease

“…MHC class II heterodimers are com-C.S. Hourigan: Molecular basis of coeliac disease Table 1 Conditions associated with coeliac disease Addison's disease [10] Inflammatory bowel disease [18] Autoimmune cholangitis [11] Iron deficiency anaemia [19] Autoimmune hepatitis [12] IgA deficiency [20] Autoimmune myocarditis [13] Neuropathy [21,22] Dermatitis herpetiformis [14] Primary biliary cirrhosis [23] Down's syndrome [15] Sarcoidosis [24] Epilepsy [16] Sjogren's syndrome [25] Diabetes mellitus type I [17] Thyroid disease [26] plexes of a two-domain 32-34-kDa α chain and a twodomain 29-32-kDa β chain. The role of MHC Class II complexes is to present extracellular (e.g., bacteria, toxins) and intravesicular (e.g., intravesicular bacteria, parasites) pathogenic material, degraded in low pH endocytic vesicles, to the cell surface of professional antigen presenting cells (APCs) for recognition by CD4 + T lymphocytes [35].…”