Hashimoto′s thyroiditis associated Evans syndrome: A rare case report on the clustered autoimmune disease triad

Abstract

Evans syndrome is a rare combination of autoimmune hemolytic anemia and immune thrombocytopenia. Their association with autoimmune thyroid diseases has been reported by few authors; however, a sequential development of the Evans syndrome in cases of Hashimoto's thyroiditis is extremely rare. The clustering of these autoimmune diseases might share a common pathogenic pathway. We present the fourth such case in world literature, of a 34-year-old female diagnosed with Hashimoto's thyroiditis in 2006, who has been taking synthetic thyroid hormone since then. Her condition is now clinically complicated with the development of the Evans syndrome.

Evans Syndrome and Hashimoto's Thyroiditis in Pregnancy: A Case Report

“…Clinical symptoms that can be found in Evans syndrome are weakness, fatigue, lethargy, pallor, jaundice, petechiae, ecchymosis, bleeding gums, and nosebleeds. 5 In this patient, symptoms of anemia were found, such as weakness, fatigue, lethargy, and bleeding, such as ecchymosis in the abdomen, so it supports the diagnosis of Evans syndrome. Immunoserology tests such as Anti-dsDNA and Rheumatoid Factor also has been done to exclude other causes of anemia and thrombocytopenia.…”

“…This reduces the work of regulatory T cells and produces a lot of cytotoxic T cells, resulting in an autoimmune mechanism that attacks erythrocytes and platelets (Jaime-Pérez et al, 2016). Clinical examination results that can be found in Evans syndrome are that the patient will experience anemia, thrombocytopenia, poikilocytosis, increased serum lactate dehydrogenase (LDH), positive antiplatelet, enlarged liver and spleen, and positive results on direct antiglobulin test (DAT) (Koti et al 2013). In this case, there were symptoms of anemia, thrombocytopenia, positive results on the platelet antibody, and poikilocytosis in the form of burr cells on peripheral blood examination and enlargement of the liver and spleen.…”

“…Autoimmune disease is a disease in which the patient's immune system attacks the patient's body cells. Body cells that are the target of the immune system can be specific, or the immune system can affect the body system systemically (Koti, 2013). In Evans syndrome, the immune system attacks blood cells in humans.…”

Anemia in thyroid diseases

“…To date, a few cases of HT and Evans syndrome have been described. 71 Comorbidity of Graves disease and Evans syndrome is also rare, and to the best of arthritis, SLE, or juvenile arthritis. In a study by Aikawa et al, 80 antithyroid autoantibodies were detected in 24% of patients with juvenile SLE.…”

A case of Evans syndrome associated with autoimmune thyroiditis

“…13 Only four cases with an association of Evans syndrome and Hashimoto's thyroiditis were found in the literature and have been described solely in adult patients. [14][15][16][17] On the other hand, thyroid abnormalities could be a presentation in different non-endocrine autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, polyarthritis, Crohn disease and myasthenia gravis. Few recent reports confirm the association with autoimmune hematologic diseases as pernicious anemias, hemolytic anemias and idiopathic thrombocytopenic purpura.…”