Vitiligo as the Presenting Manifestation of Sjogren’s Syndrome: Case Report and Review of Vitiligo and Its Associated Autoimmune Conditions

Abstract

Vitiligo is a cutaneous condition that causes loss of pigmentation; it can be associated with other autoimmune conditions. Sjogren’s syndrome is a chronic inflammatory autoimmune condition that classically presents with xerophthalmia and xerostomia. Rarely, vitiligo has occurred in individuals with Sjogren’s syndrome. A 51-year-old Hispanic woman presented with vitiligo. Her laboratory investigation was consistent with Sjogren’s syndrome; she subsequentially developed xerophthalmia and arthritis. The association between vitiligo and other autoimmune conditions is reviewed and the association of vitiligo and Sjogren’s syndrome is discussed.

Vitiligo-Associated Autoimmune Disorders: A Woman With Vitiligo and Incipient Hypothyroidism

“…In addition to thyroid diseases, such as Hashimoto's disease and Graves' disease, vitiligo has been observed in patients with other autoimmune conditions, including dermatologic, endocrine, hemolytic, and neurologic conditions (Table 1) [5,[13][14][15][16]. Endocrine disorders associated with vitiligo include Addison's disease and diabetes.…”

“…The autoimmune theory proposes that patients with vitiligo have autoimmunity in which there is a destruction of melanocytes as a result of genetic and environmental factors. Indeed, vitiligo has also developed concurrently in patients with other autoimmune conditions, such as thyroid disease [ 2 , 5 , 6 ].…”

“…Laboratory studies should be considered to evaluate a patient with vitiligo. They include lupus erythematosus serologies (antinuclear antibody titer, anti-double-stranded DNA antibody, anti-ribonucleoprotein antibody, anti-scleroderma-70 antibody, anti-Sjogren’s syndrome-related antigen A antibody, anti-Sjogren’s syndrome-related antigen B antibody, and anti-Smith antibody), complete blood cell and platelet counts, serum chemistries, and a thyroid function panel (thyroid-stimulating hormone, triiodothyronine, and thyroxine) [ 5 ]. Since thyroid disease is prevalent in patients with vitiligo, it is reasonable to not only order a thyroid function panel but also thyroid antibodies (anti-peroxidase antibody and anti-thyroglobulin antibody).…”