title: A rare combination of type 3 autoimmune polyendocrine syndrome (APS-3) or multiple autoimmune syndrome (MAS-3).
abstract: BACKGROUND
  Type 3 autoimmune polyendocrine syndrome (APS-3) is defined by the presence of an autoimmune thyroid disease and another autoimmune illness, excluding Addison's disease; this is a frequent combination.
  
  
  METHODS
  We report the case of a 55 years old female patient with APS-3, with seven clinical or latent autoimmune manifestations. At 49 years of age she was admitted at the General Hospital for leukopenia, weight loss, tremors, anxiety and diarrhea. The personal history revealed ulcerative colitis and, during the last year, episodes of fever with migrant arthralgia and cutaneous lesions. The patient was evaluated for thyroid function and imaging, mielobiopsy, glycaemic control, gastrointestinal and rheumatologic disorders with specific biochemical tests, imaging and endoscopic procedures. We concluded that the patient was affected by APS-3, characterized by the association of Graves' disease, autoimmune leukopenia, latent autoimmune diabetes of the adult (LADA), autoimmune gastritis, ulcerative colitis, Sjögren's and anti-phospholipid syndromes. The patient started low doses of corticosteroid drugs for leukopenia, underwent (131)I therapy for hyperthyroidism and later started substitutive thyroid therapy with l-thyroxine, insulin therapy for LADA, mesalazine for ulcerative colitis and artificial tears for Sjögren's syndrome.
  
  
  CONCLUSIONS
  In this article we report a complex case of APS-3, characterized by the association of seven different autoimmune diseases, which required a complex therapeutic strategy.
authors.affiliation: Endocrine Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100 Padua, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Betterle
authors.affiliation: Endocrine Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100 Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garelli
authors.affiliation: Endocrine Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100 Padua, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Coco
authors.affiliation: Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
keywords: Autoimmune gastrointestinal disorders; Autoimmune polyendocrine syndrome type 3; Diabetes mellitus type 1; Graves’ disease; Multiple autoimmune syndrome type 3