Autoimmune polyendocrine syndrome type IIIC and ankylosing spondylitis: a case report

Document Type: Case Report

Authors

1 Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Autoimmune polyendocrine syndrome (APS) is an autoimmune disorder defined by multiple endocrinopathies and the presence of other systemic or organ-specific autoimmunities. This case study, reports on a 46-year-old woman with confirmed idiopathic hyperparathyroidism, who was referred for inflammatory back pain. HLA-B27 positivity, recurrent anterior uveitis and radiologic findings led to ankylosing spondylitis (AS) diagnosis. By further investigations, a subclinical atrophic autoimmune thyroid disease (AITD) was also diagnosed for her in addition to a history of premature ovarian failure. According to the absence of adrenal insufficiency in addition to an AITD and systemic autoimmune disorder, APS type IIIC was the most probable diagnosis. To the best of our knowledge, this is the first case report of APS type III associated with AS.

Keywords


Cutolo M. Autoimmune polyendocrine syndromes. Autoimmun Rev. 2014; 13(2): 85-9. doi:10.1016/j.autrev.2013.07.006.

Goswami R, Ray D, Sharma R, Tomar N, Gupta R, Gupta N, et al. Presence of spondyloarthropathy and its clinical profile in patients with hypoparathyroidism. Clin Endocrinol (Oxf). 2008; 68(2): 258-63. doi: 10.1111/j.1365-2265.2007.03032.x.

Kajitani TR, Silva RV, Bonfa E, Pereira RM. Hypoparathyroidism mimicking ankylosing spondylitis and myopathy: a case report. Clinics (Sao Paulo). 2011; 66(7): 1287-90.

Shimomura H, Nakase Y, Furuta H, Nishi M, Nakao T, Hanabusa T, et al. A rare case of autoimmune polyglandular syndrome type 3. Diabetes Res Clin Pract. 2003; 61(2): 103-8.

Betterle C, Garelli S, Coco G, Burra P. A rare combination of type 3 autoimmune polyendocrine syndrome (APS-3) or multiple autoimmune syndrome (MAS-3). Auto Immun Highlights. 2014; 5(1): 27-31. doi: 10.1007/s13317-013-0055-6.

Zlotogora J, Shapiro MS. Polyglandular autoimmune syndrome type I among Iranian Jews. J Med Genet. 1992; 29(11): 824-6.

Schneller C, Finkel L, Wise M, Hageman JR, Littlejohn E. Autoimmune polyendocrine syndrome: a case-based review. Pediatr Ann. 2013; 42(5): 203-8. doi: 10.3928/00904481-20130426-12.

Flynn SD, Nishiyama RH, Bigos ST. Autoimmune thyroid disease: immunological, pathological, and clinical aspects. Crit Rev Clin Lab Sci. 1988; 26(1): 43-95. doi: 10.3109/10408368809105889.

Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014; 13(4-5): 391-7. doi: 10.1016/j.autrev.2014. 01.007.

Emmungil H, Erdogan M, Kalfa M, Karabulut G, Kocanaogullari H, Inal V, et al. Autoimmune thyroid disease in ankylosing spondylitis. Clin Rheumatol. 2014; 33(7): 955-61. doi: 10.1007/s10067-013-2466-1.

Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291(2): 228-38. doi: 10.1001/jama.291.2.228.

Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016.

Kim SJ, Kim SY, Kim HB, Chang H, Cho HC. Polyglandular Autoimmune Syndrome Type III with Primary Hypoparathyroidism. Endocrinol Metab (Seoul). 2013; 28(3): 236-40. doi: 10.3803/EnM.2013.28.3. 236.

Illeez Memetoglu O, Unlu Ozkan F, Taraktas A, Aktas I, Nazikoglu C. Idiopathic Hypoparathyroidism Mimicking Ankylosing Spondylitis: A Case Report. Acta Reumatol Port. 2015.

Ibn Yacoub Y, Rostom S, Hajjaj-Hassouni N. Uncommon case of ankylosing spondylitis associated with spontaneous occurring hypoparathyroidism. Rheumatol Int. 2011; 31(5): 681-3. doi: 10.1007/s00296-009-1220-0.