Psoriasis, Vitiligo and Crohn's Disease Co-Existing in a Single Patient: A Variant Type of Multiple Autoimmune Syndrome?

Abstract

Multiple autoimmune syndrome (MAS) is a rare condition, in which at least three well-defined autoimmune diseases co-occur in a single patient. Although the pathogenesis of MAS remains poorly understood, genetic, immunological, hormonal, and environmental factors may all play a role. Although three classic subtypes of MAS are well known, several cases that could not be placed into any of these three categories have recently been reported. To the best of our knowledge, the co-existence of psoriasis, vitiligo, and Crohn's disease has been reported in only one patient, who had a total of five autoimmune diseases (alopecia areata and oral lichen planus in addition to the three conditions mentioned). We herein describe a rare case of MAS presenting with psoriasis, vitiligo, and Crohn's disease, and suggest that tumor necrosis factor-α may be associated with the pathogenesis of all three conditions.

Keywords: Autoimmune diseases; Crohn disease; Psoriasis; Vitiligo.

Fig. 1. (A) Multiple hypopigmented patches on the chest that developed gradually but had recently coalesced. (B) A newly developed, well-demarcated hypopigmented patch on the abdomen. (C) Hyperkeratotic plaques on both elbows.

Fig. 2. An erythematous scaly plaque on the scalp.

Fig. 3. A scalp skin biopsy revealed parakeratosis and regular acanthosis, with elongated and clubbed rete ridges. Suprapapillary thinning of the epidermis, and dilation of the capillaries of the dermal papillae were observed. Perivascular lymphocyte infiltration in the upper dermis was apparent (H&E, ×100).

Fig. 4. (A) Linear aphthous ulcers seen on endoscopic examination. (B) Hemorrhagic colonic mucosa with a cobblestone-like appearance.