Dieli-Crimi R, Núñez C, Estrada L, López-Palacios N

Language: English
References: 20
Page: 588-591
PDF size: 191.84 Kb.

ABSTRACT

Autoimmune polyglandular syndrome (APS) is a combination of different autoimmune diseases. The close relationship between immune- mediated disorders makes it mandatory to perform serological screening periodically in order to avoid delayed diagnosis of additional autoimmune diseases. We studied a patient with type 1 diabetes (T1D) who later developed an autoimmune thyroid disease (ATD) and was referred to our hospital with a serious condition of his clinical status. The patient was suffering from an advance stage of celiac disease (CD), the delay in its diagnosis and in the establishment of a gluten-free dietled the patient to a severe proteincalorie malnutrition. Later, the patient developed an autoimmune hepatitis (AIH). We consider that clinical deterioration in patients with APS should alert physicians about the possible presence of other immune-mediated diseases. Periodic screening for autoantibodies would help to prevent delayed diagnosis and would improve patient’s quality of life.

REFERENCES

1. Neufeld M, Maclaren N, Blizzard R. Autoimmune polyglandular syndromes. Pediatr Ann 1980; 9:154-62.

2. Cutolo M. Autoimmune polyendocrine syndromes. Autoimmun Rev 2014;13:85-9.

3. Michels AW, Gottlieb PA. Autoimmune polyglandular syndromes. Nat Rev Endocrinol 2010; 6: 270-7.

4. Oki K, Yamane K, Koide J, Mandai K, Nakanishi S, Fujikawa R, Kohno N. A case of polyglandular autoimmune syndrome type III complicated with autoimmune hepatitis. Endocr J 2006; 53: 705-9.

5. Kahara T, Wakakuri H, Takatsuji J, Motoo I, Shima KR, Ishikura K, Usuda R, et al. Autoimmune polyglandular syndrome type 3 with anorexia. Case Rep Endocrinol 2012; 2012: 657156.

6. De Marchi SU, Cecchin E, De Marchi S. Autoimmune spontaneous chronic urticaria and generalized myasthenia gravis in a patient with polyglandular autoimmune syndrome type 3. Muscle Nerve 2015; 52: 440-4.

7. Hansen MP, Matheis N, Kahaly GJ. Type 1 diabetes and polyglandular autoimmune syndrome: A review. World J Diabetes 2015; 6: 67-79.

8. Bai JC, Fried M, Corazza GR, Schuppan D, Farthing M, Catassi C, Greco L, et al. World gastroenterology organisation global guidelines on celiac disease. J Clin Gastroenterol 2013; 47: 121-6.

9. Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PH, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 2014; 63: 1210-28.

10. Mieli-Vergani G, Vergani D. Autoimmune hepatitis. Nat Rev Gastroenterol Hepatol 2011; 8: 320-9.

11. Teufel A, Weinmann A, Kahaly GJ, Centner C, Piendl A, Worns M, Lohse AW, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol 2010; 44: 208-13.

12. van Gerven NM, Bakker SF, de Boer YS, Witte BI, Bontkes H, van Nieuwkerk CM, Mulder CJ, et al. Seroprevalence of celiac disease in patients with autoimmune hepatitis. Eur J Gastroenterol Hepatol 2014; 26: 1104-7.

13. Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev 2002; 23: 327-64.

14. Betterle C, Zanchetta R. Update on autoimmune polyendocrine syndromes (APS). Acta Biomed 2003; 74: 9-33.

15. Dittmar M, Kahaly GJ. Genetics of the autoimmune polyglandular syndrome type 3 variant. Thyroid 2010; 20: 737-43.

16. Cosnes J, Cellier C, Viola S, Colombel JF, Michaud L, Sarles J, Hugot JP, et al. Incidence of autoimmune diseases in celiac disease: protective effect of the gluten-free diet. Clin Gastroenterol Hepatol 2008; 6: 753-8.

17. Primo J, Merino C, Fernandez J, Moles JR, Llorca P, Hinojosa J. Incidence and prevalence of autoimmune hepatitis in the area of the Hospital de Sagunto (Spain). GastroenterolHepatol 2004; 27: 239-43.

18. deBoer YS, van Gerven NM, Zwiers A, Verwer BJ, van Hoek B, van Erpecum KJ, Beuers U, et al. Genome-wide association study identifies variants associated with autoimmune hepatitis type 1. Gastroenterology 2014; 147: 443-52 e5.

19. Vader W, Stepniak D, Kooy Y, Mearin L, Thompson A, van Rood JJ, Spaenij L, et al. The HLA-DQ2 gene dose effect in celiac disease is directly related to the magnitude and breadth of gluten-specific T cell responses. Proc Natl Acad Sci U S A 2003; 100: 12390-5.

20. Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev 2015 [Epub ahead of print].