Rare Case of SLE Reported in Man with Two Other Autoimmune Diseases, Including Celiac

Patients with one autoimmune disease should be closely monitored because they may have a higher risk of developing another autoimmune disease, according to a case study published in the journal Autoimmune Highlights.

The study, “An unusual association of three autoimmune disorders: celiac disease, systemic lupus erythematosus and Hashimoto’s thyroiditis,” reports the case of a 39-year-old man with a clinical history of psychiatric symptoms and celiac disease, who was diagnosed with two additional autoimmune disorders: systemic lupus erythematosus (SLE) and Hashimoto’s thyroiditis.

The patient originally arrived at a hospital with complaints of pain in large joints and a two-week history of fatigue and fever. He also had a clinical history of psychiatric symptoms, which started when he was 18 years old. Six months before his hospital admission, he was diagnosed with celiac disease, a genetically linked autoimmune disorder.

On further examination, the man was found to have malar, or butterfly, rash that is often seen in SLE; edema, or swelling, of the legs; and fever. Based on clinical and laboratory tests, he was diagnosed with SLE and Hashimoto’s thyroiditis, a condition in which the immune system attacks the thyroid.

“Because the patient was already suffering for CD [celiac disease], we made a final diagnosis of [multiple autoimmune syndrome],” wrote Dr. Viera Boccuti, with the Department of Interdisciplinary Medicine at the University of Bari Aldo Moro in Italy, and a study co-author.

The patient was treated with the anti-inflammatory drug Medrol (methylprednisolone) for SLE, and with the synthetic thyroid hormone levothyroxine for Hashimoto’s thyroiditis. These treatments yielded good initial clinical and laboratory response, and the doctors advised the patient to continue on a strictly gluten-free diet for his celiac disease.

“This case … highlights the importance to make a good clinical surveillance in patients with one autoimmune disorder,” the study’s authors concluded.

Multiple autoimmune syndrome is a relatively new concept in medicine, introduced to describe patients with at least three autoimmune diseases. Although it is rare to see multiple autoimmune diseases in a single patient, an increased risk of other autoimmune disorders has been reported in patients with celiac disease. But, to date, only some case reports suggest an association between celiac disease and SLE.