title: Coexistence of five autoimmune diseases: diagnostic and therapeutic difficulties.
abstract: We report the case of coexistence of five autoimmune diseases in a 36-year-old woman, who initially developed psoriasis. Several years later, the patient was diagnosed with a mixed connective tissue disease and primary biliary cirrhosis (PBC). On admission to the Department of Rheumatology and Connective Tissue Diseases, the patient fulfilled classification criteria of an overlap syndrome systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome/systemic sclerosis (SSc)/Sjogren's syndrome (SS) with coexisting PBC and psoriasis. The SLE symptoms included discoid lupus erythematosus, arthritis, pancytopenia, antinuclear antibodies and anticardiolipin antibodies. Moreover, the patient met the criteria of antiphospholipid syndrome diagnosed based on preterm delivery before week 34, and high values of anticardiolipin antibodies were found at repeated determinations. The SSc symptoms included sclerodactyly, pulmonary fibrosis with pulmonary hypertension and esophageal dysfunction. The SS syndrome involved xerostomia, xerophthalmia, the positive Schirmer's test and presence of anti-SS antibodies. The literature reports overlap syndromes in various combinations; however, the coexistence of five autoimmune diseases is extremely rare.
authors.affiliation: Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 Street, 20-090, Lublin, Poland. ewaw1973@op.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Wielosz
authors.forename: Maria
authors.initials: M
authors.lastname: Majdan
authors.forename: Iwona
authors.initials: I
authors.lastname: Zychowska
authors.forename: Radosław
authors.initials: R
authors.lastname: Jeleniewicz
mesh_terms: D000328:Adult; D003240:Connective Tissue Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D013577:Syndrome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide