title: A 20-year-old woman with Hashimoto's thyroiditis and Evans' syndrome.
abstract: Here we report the case of a 20-year-old female patient previously diagnosed with Hashimoto's thyroiditis and overt hypothyroidism, and who had been taking synthetic thyroxine (100 microg/day) for eight months. She experienced intermittent dizziness and generalized weakness, and was diagnosed as having severe autoimmune hemolytic anemia (AIHA). We prescribed prednisolone treatment and continued synthetic thyroxine administration. Two years and five months later, she developed idiopathic thrombocytopenic purpura (ITP) and was diagnosed with Evans' syndrome. Thereafter, laparoscopic splenectomy was performed because her autoimmune hemolytic anemia was refractory and dependent on steroid therapy. The HLA genotypes of the patient were HLA-A*020101/A* 2602, HLA-B*270502/B*5401, HLA-Cw*0102/Cw*020202, HLA-DRB1*0404/DRB1*0405, and HLA-DQB1*0302/DQ B1*0401. Hashimoto's thyroiditis is often associated with other nonendocrine autoimmune diseases, and antithyroid antibodies are frequently observed in Evans' syndrome (coexistence of AIHA and ITP). However, there is no report of Evans' syndrome developing in patients with overt hypothyroidism and Hashimoto's thyroiditis. This case suggests that three autoimmune diseases (AIHA, ITP, and Hashimoto's thyroiditis) might share a common immunogenetic pathway in pathogenesis.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University, Jinju 660-702, Korea.
authors.forename: Mi Yeon
authors.initials: MY
authors.lastname: Kang
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Jung
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Deok Ryong
authors.initials: DR
authors.lastname: Kim
authors.forename: Myoung Hee
authors.initials: MH
authors.lastname: Park
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications*; D005260:Female; D050031:Hashimoto Disease / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D011696:Purpura, Thrombocytopenic / Q000097:blood / Q000150:complications*; D011877:Radionuclide Imaging