Exceptional manifestation of polyautoimmunity in a very young girl – a case report

Abstract

Polyautoimmunity is defined as the presence of more than one autoimmune disease in a single patient. The exact pathogenic mechanisms responsible for the coexistence of distinct autoimmune diseases within an individual have not been clearly explained. We report a case of a very young girl with the extremely rare co-existence of four distinct autoimmune diseases i.e. juvenile idiopathic arthritis, type 1 diabetes mellitus, coeliac disease and autoimmune hepatitis, recognized based on validated international classification criteria. The best to our knowledge there has been no case reporting coexistence of these particular four disorders in an individual. Moreover, all these diseases occurred during first three years of life, which also cause that case unique. Molecular studies of human leukocyte antigen (HLA) class II in our patient showed the presence of the HLA DRB1*01, HLA DRB1*03, HLA DQB1*02, HLA DQB1*05 molecules, which may suggest immunogenetic links between those autoimmune diseases. The presented case highlights the importance of active screening for other autoimmune diseases, if a patient with one autoimmune disease manifests with new or nonspecific symptoms.

Liver sinusoidal endothelial cells in morphogenesis of pediatric autoimmune hepatitis. Ultrastructural characteristics – a novel report

“…Clinical manifestations of autoimmune hepatitis (AIH) -a chronic immune-mediated, autodestructive liver disease, requiring long-term immunosuppressive therapy, range from mild chronic to acute, sometimes fulminant hepatitis. Unfortunately, the pathological mechanisms of the disease are not yet fully understood because of the lack of suitable animal models [1,2,3,4,5,6,7].…”

Coincidence of juvenile idiopathic arthritis and type 1 diabetes: a case-based review

“…Because JIA is a relatively rare disease, only a few cases of clustering JIA and type 1 diabetes were published in the last years [10][11][12][13]. The vast majority of available case reports were girls, typically for autoimmune diseases (except for T1D, where both sexes are at similar risk of the disease).…”

“…It is worth mentioning that some patients become GCS-dependent for proper JIA control; GCS have to be administrated due to recurrence of symptoms (or to be tapered slowly) [ 10 , 13 ]. Notwithstanding, major therapeutic issues in JIA are not only side effects of GCS.…”

“…We also scrutinized the reference lists of the included studies to identify additional references. Four case studies that met the adopted criteria were found [10][11][12][13]. Furthermore, we reported the history of two children treated in an academic tertiary care hospital; medical records, direct examination, and clinical assessment were used.…”