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A Case of Combined Autoimmune Pathology: Systemic Scleroderma, Sjögren's Syndrom, Type 1 Diabetes, Chronic Autoimmune Thyroiditis, Fetal Adenoma
Introduction: Autoimmune diseases are often combined. Some of them are hereditary, but a cluster of type 1 diabetes, scleroderma, Sjogren's syndrome and autoimmune thyroiditis with fetal adenoma has never been described before.
Clinical case: We have been observing a 62-year-old patient since January 2014. Since the age of 42 (1985) she has had chronic autoimmune thyroiditis and nodular goitre. In 2002 a biopsy discovered fetal adenoma. Systemic scleroderma dates back to the same year, while Sjögren's syndrome was first diagnosed in 1998. The patient was treated with methylprednisolonum, but skin and systemic symptoms persisted. In 2002 at the age of 50, the patient complained of weight loss, thirst, mouth dryness, frequent urination and was diagnosed with type 2 diabetes, fasting glycemia up to 226.8 mg/dl. Peroral sugar-reducing therapy was prescribed to little effect. In 2010, due to a low level of basal C-peptide (0.75 ng/ml), the diagnosis was changed to type 1 diabetes, insulin therapy was prescribed to good clinical effect. In 2014 diabetic nephropathy at the stage of microalbuminuria was diagnosed. Discussion: In this case differential diagnosis is between the secondary (steroidogenic) diabetes, type 2 and type 1 diabetes. Considering the lack of metabolic syndrome manifestations, the co-occurring autoimmune diseases, signs of stable insuline deficiency as a result of autoimmune damage to beta cells, positive anti-bodies to GAD, most likely we have a case of type 1 diabetes here (LADA). Conclusion: First reported combination of systemic scleroderma, Sjögren's syndrome, type 1 diabetes, autoimmune thyroiditis, fetal adenoma demonstrates the necessity of further exploration of combined autoimmune endocrine pathology, including molecular and genetic research.