Case Report: Multiple autoimmune syndrome (MAS)-An unusual combination

Area of Science:

• Pediatric Rheumatology
• Endocrinology
• Immunology

Background:

• Multiple Autoimmune Syndrome (MAS) involves the co-occurrence of two or more distinct autoimmune diseases.
• Childhood-onset autoimmune diseases, such as type 1 diabetes, Hashimoto thyroiditis, and systemic lupus erythematosus (SLE), can present concurrently.
• Understanding the interplay between different autoimmune conditions is crucial for effective patient management.

Observation:

• A Chinese adolescent presented with a rare triad of autoimmune diseases: type 1 diabetes, Hashimoto thyroiditis, and childhood-onset systemic lupus erythematosus (SLE).
• Systemic lupus erythematosus (SLE) developed within one year of initial symptom onset.
• Clinical presentation of SLE included necrotising histiocytic lymphadenitis and hepatitis.

Findings:

• The patient exhibited a rare combination of type 1 diabetes, Hashimoto thyroiditis, and childhood-onset SLE.
• The rapid progression to SLE highlights the potential for swift development of new autoimmune manifestations.
• Shared subphenotypes and non-specific autoantibodies underscore the complexity of autoimmune overlap syndromes.

Implications:

• Physicians must maintain a high index of suspicion for developing new autoimmune diseases in patients with pre-existing conditions.
• Continuous surveillance is essential for early detection and management of emerging autoimmune disorders.
• Recognizing overlap syndromes is critical for comprehensive diagnosis and long-term patient care in pediatric autoimmune diseases.