A Letter

Multiple Autoimmune Syndrome: Celiac Disease, Hashimoto's Thyroiditis, and Systemic Lupus Erythematosus  

Nabil Belfeki1 , Souheil Zayet2 , Imed Ben Ghorbel1 , Mohamed Habib Houman1
1 Department of Internal Medicine, University Hospital of La Rabta, Tunis, Tunisia
2 Department of Infectious Disease, University Hospital of La Rabta, Tunis, Tunisia
Author    Correspondence author
International Journal of Clinical Case Reports, 2017, Vol. 7, No. 1   doi: 10.5376/ijccr.2017.07.0001
Received: 24 Feb., 2017    Accepted: 15 Mar., 2017    Published: 05 Apr., 2017
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Preferred citation for this article:

Belfeki N., Zayet S., Ghorbel I.B., and Houman M.H., 2017, Multiple autoimmune syndrome: celiac disease, hashimoto’s thyroiditis, and systemic lupus erythematosus, International Journal of Clinical Case Reports, 7(1): 1-3 (doi: 10.5376/ijccr.2017.07.0001)


Multiple autoimmune syndrome is the association of three or more autoimmune diseases in the same patient. We report the case of a 24-year-old woman with a medical past history of celiac disease since the age of 3. She complained of fatigue, malar rash, and paresthesia of the lower limbs. Physical examination objectified fever at 38°C and butterfly rash. Cell blood count showed leucopenia and lymphopenia. Thyroid tests concluded to primary hypothyroidism. Immunological investigations revealed positive antinuclear antibodies (1/3200), anti-DNA, and thyroperoxydase antibodies. The HLA haplotype typing was A1 A26 B50 B16 DR3 DR52 DQ2. The diagnosis of multiple autoimmune syndrome associating systemic lupus erythematosus, celiac diasese, and Hashimoto’s thyroiditis was retained. The patient was treated with hydroxychloroquine 400 mg/day and L-thyroxine 100 µg/day. The global outcome was favorable and the patient was free of symptoms. The decline is 10 years. The current case is unique in this aspect that the combination of these three autoimmune disorders has rarely been reported in the past.

Multiple autoimmune syndrome; Systemic Lupus Erythematosus; Celiac disease; Hashimoto’s thyroiditis
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