Latif Shahbaz, Jamal Ammarah, Memon Iqbal, Yasmeen Shagufta, Tresa Veena, Shaikh Sattar
Paediatric Unit II, Dow University of Health Sciences (DUHS) and Civil Hospital, Karachi.
J Pak Med Assoc. 2010 Oct;60(10):863-5.
Various autoimmune diseases have association with each other but it is very rare to see multiple autoimmune diseases in one patient. Presence of more than two autoimmune diseases in one patient is known as multiple autoimmune syndrome (MAS). We report the case of an 11 years old girl who presented with history of swelling in front of the neck along with constipation, anorexia, weight gain and increasing pallor over a period of six months. Additionally she had an episodic history of joint pains and abdominal pain with no specific relation to diet, time, other gastrointestinal or genitourinary symptom. Hypothyroid goiter (Autoimmune thyroiditis, Hashimoto's thyroidits) was diagnosed by raised thyroid stimulating hormone (TSH), low T4 and presence of thyroid specific antibodies in blood. Patient was discharged on tablet Levothyroxine to which she responded well with reduction in size of the swelling and relief of the symptoms except for the joint pains and abdominal pain. To evaluate the persistent symptoms she was investigated further for other autoimmune diseases and was diagnosed to be having systemic lupus erythematosus (SLE) and Coeliac disease also. The final diagnosis was multiple autoimmune syndrome (Hashimoto's thyroiditis, Coeliac disease and SLE).
多种自身免疫性疾病之间存在关联，但在一名患者身上同时出现多种自身免疫性疾病的情况非常罕见。一名患者身上存在两种以上自身免疫性疾病被称为多发性自身免疫综合征（MAS）。我们报告了一名11岁女孩的病例，她在六个月的时间里出现了颈部前方肿胀的病史，同时伴有便秘、厌食、体重增加和面色苍白加重。此外，她有发作性关节疼痛和腹痛病史，与饮食、时间、其他胃肠道或泌尿生殖系统症状无特定关系。通过血液中促甲状腺激素（TSH）升高、T4降低以及甲状腺特异性抗体的存在，诊断为甲状腺功能减退性甲状腺肿（自身免疫性甲状腺炎，桥本甲状腺炎）。患者出院时服用左甲状腺素片，除关节疼痛和腹痛外，肿胀大小减小且症状缓解，她对此反应良好。为评估持续存在的症状，她进一步接受了其他自身免疫性疾病的检查，还被诊断出患有系统性红斑狼疮（SLE）和乳糜泻。最终诊断为多发性自身免疫综合征（桥本甲状腺炎、乳糜泻和SLE）。
