Probable Multiple Autoimmune Syndrome in a Patient with Vitiligo, Autoimmune Thyroiditis, and Diabetes Mellitus: A Case Report

Introduction: Multiple autoimmune syndrome (MAS) is a rare syndrome in which the patient is diagnosed with three or more autoimmune diseases. Autoimmune skin disorders, such as vitiligo, alopecia areata, lupus erythematosus, Sjogren's syndrome, or dermatitis herpetiformis, often take part in MAS. The etiology of the syndrome is still unknown, but immunological, hormonal, genetic, and environmental factors possibly play a role. Case Presentation: A 63-year-old woman was admitted to our department with a rare combination of several autoimmune diseases, including vitiligo, autoimmune thyroiditis, and recently diagnosed diabetes mellitus. Although the immediate cause of her hospitalization was erysipelas of the left leg, type 3 MAS was suspected, based on the simultaneous presence of three autoimmune diseases. Type 3 MAS groups together conditions such as autoimmune thyroid disease, myasthenia gravis, thymoma, Sjogren's syndrome, pernicious anemia, idiopathic thrombocytopenic purpura, Addison’s disease, type 1 diabetes mellitus, vitiligo, autoimmune hemolytic anemia, systemic lupus erythematosus, and dermatitis herpetiformis. The only criterion that needed to be fulfilled in our case, to establish the diagnosis of type 3 MAS, was a specific subtype of diabetes, namely, late-onset autoimmune diabetes (LADA). Conclusions: We presented a patient with possible type 3 MAS. Further investigations are needed for the diagnosis of LADA by a more precise serological examination of anti-IA and anti-GAD 65 antibodies.