Title : Multiple Autoimmune Syndrome: Combination of Neuromyelitis Optica Spectrum Disorder with Myastenia Gravis, Systemic Lupus Erythamatosis and Hashimato Tiroiditis
Autoimmunity reflects an altered immune status, therefore the presence of more than one disorder is not uncommon. The coexistence of three or more autoimmune diseases in a patient constitutes multiple autoimmune syndrome (MAS). This is an interesting case of a middle-aged female in whom clinical signs of NMOSD and MG co-occurred and got the diagnosis of SLE and thyroiditis during her evaluation.
A 31-year-old female patient was admitted to our clinic with complaints of diplopia, severe nausea-vomiting, balance disorder, fever, and widespread muscle aches. Family history was unremarkable for any autoimmune disorder. She was a diagnosed case of hashimato tiroiditis. MRI examination revealed a T2 hyperintense lesion extending from the bulbus to the posterior pons. In the examinations, Aq4 antibody was positive, antinuclear antibodies (ANA) test was strongly positive. Laboratory workup showed normal complete blood counts, markedly elevated transaminases and alkaline phosphates. During the follow-up period, acetylcholine receptor antibody was positive, which was examined due to fluctuating eye findings, nazone speech, and dysphagia. High fever, evoloemic hyponatremia was evaluated as central origin. Pericardial effusion detected in cardiac examination and pleural effusion observed in thorax Bt were associated with rheumatologic picture. In addition to high-dose pulse steroid and plasmapheresis treatments, multidisciplinary treatments were arranged. The patient, whose rituximab treatment was started, is followed up without clinical worsening and disability in the two-year follow-up.
Patients with diagnosis of NMOSD need special attention as multiple immune-mediated disorders may be present simultaneously or sequentially during the course of the disease process. These patients need close surveillance for the development of another autoimmune disease, so as to control the current disease and to prevent future complications.
What will audience learn from your presentation?
- Neuromyelitis Optica Spectrum Disorders is an autoimmune inflammatory demyelinating disease of the central nervous system.
- There have been many reports on its association with other disorders including systemic and organ specific autoimmune diseases. However, in the literature it is rare that all of these co-existing autoimmune diseases.
- This case report emphasizes the importance of a multidisciplinary team approach for a better understanding of disorders related to the breakdown of immune tolerance.
- ?t is important that of adequate immunological education with clinical information for positive future outcomes and patient management