Autoimmune polyglandular syndrome type III which accompanies to multiple sclerosis: A case report
Autoimmune polyglandular syndrome type III which accompanies to multiple sclerosis: A case report
Autoimmune polyglandular syndrome type III (APS III) is characterised by autoimmune destruction of various endocrine and nonendocrine tissues. It differs from APS I and APS II in terms of without adrenal involvement. Although APS III includes a series ofautoimmune disorders, it is rarely associated with multiple sclerosis (MS). A 41-year-old female patient had diplopia, visual blurring,dizziness, and giddiness for 2 weeks. In her medical history, she had a diagnosis of MS and using Teriflunomide. It was detectedpositivity of antinuclear antibody (ANA), anti-thyroid peroxidase (Anti-TPO) and anti-thyroglobulin (Anti-TG) antibodies. Based onthese results, the patient with MS who has chronic autoimmune thyroiditis and primary ovarian failure was diagnosed with APSIII. The coexistence of APS-III and MS is a rare clinical entity. Moreover, hypothyroidism has been detected during teriflunomidetherapy in the patient. Hypothyroidism was most likely a component of APS-III in our case, but it may also have been triggered byteriflunomide.
___
- 1. Neufeld M, Blizzard RM. Polyglandular autoimmune disease. In: Pinchera A, Doniach D, Fenzi DF, Baschieri L, eds. Autoimmune aspects of endocrine disorders. London, UK: Academic Press 1980;357-365.
- 2. Kasznicki J, Drzewoski J. A case of autoimmune urticaria accompanying autoimmune polyglandular syndrome type III associated with Hashimoto’s disease, type 1 diabetes mellitus, and vitiligo. Endokrynol Pol 2014;65:320-3.
- 3. Popescu BF, Lucchinetti CF. Pathology of demyelinating diseases. Ann Rev Pathol 2012;7:185-217.
- 4. Maddison P, Kiely P, Kirkham B, et al. Leflunomide in rheumatoid arthritis: recommendations through a process of consensus. Rheumatology (Oxford) 2005;44:280-6.
- 5. Bruneau JM, Yea CM, Spinella-Jaegle S, et al. Purification of human dihydro-orotate dehydrogenase and its inhibition by A77 1726, the active metabolite of leflunomide. Biochem J 1998;336:299-303.
- 6. Xu X, Blinder L, Shen J, et al. In vivo mechanism by which leflunomide controls lymphoproliferative and autoimmune disease in MRL/MpJ-lpr/lpr mice. J Immunol. 1997;159:167-74.
- 7. Iraj Salehi-Abari. ACR/SLICC Revised Criteria for Diagnosis of Systemic Lupus Erythematosus. Autoimmune Dis Ther Approaches 2015;2:114.
- 8. North American Menopause Society. Early menopause guidebook. 6th edition. Cleveland, OH: North American Menopause Society 2006.
- 9. Kalu E, Panay N. Spontaneous premature ovarian failure: management challenges. Gynecol Endocrinol. 2008;24:273-9.
- 10. Boz C, Velioglu S, Altunayoglu V, et al. Central nervous system involvement in autoimmune polyglandular syndrome. Clinical Neurology and Neurosurgery 2003; 105:102-4.
- 11. Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler 2004;10:575-81.
- 12. Yokote H, Nagasawa M, Ichijo M, et al. Autoimmune polyendocrine syndrome-3 in a patient with lateonset multiple sclerosis. Neurologist. 2012;18:83-4.
- 13. Masuda S, Mori M, Hamada S, et al. Autoimmune polyendocrine syndrome type 3 in a multiple sclerosis patient. Clinical and Experimental Neuroimmunology 2015;6:299-303.
- 14. Flores J, Rito Y, Torres G, et al. Hypothyroidism in multiple sclerosis patient during fingolimod treatment. J Neurol Sci 2015;348:272-3.
- 15. Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med 2001;344:1743-9.