Abstract
Warm antibody autoimmune hemolytic anemia is due to the presence of warm agglutinins that react with protein antigens on the surface of red blood cells causing premature destruction of circulating red blood cells. We report the first case of concurrent reactive arthritis, Graves’ disease, and autoimmune hemolytic anemia. A 40-year-old man with reactive arthritis, Graves’ disease, type 2 diabetes mellitus, mitral valve prolapse, and Gilbert’s disease presented with a one month history of jaundice, fatigue, and black stools. After diagnosis of warm autoimmune hemolytic anemia, the patient was started on prednisone 1 mg/kg with rapid improvement in his anemia and jaundice. Our subject’s mother and possibly his maternal grandmother also had autoimmune hemolytic anemia, which raises the possibility of hereditary autoimmune hemolytic anemia, a rarely reported condition.
Highlights
Warm antibody autoimmune hemolytic anemia is due to the presence of warm agglutinins that react with protein antigens on the surface of red blood cells causing premature destruction of circulating red blood cells
We report the first case of concurrent reactive arthritis, Graves’ disease, and autoimmune hemolytic anemia
Autoimmune hemolytic anemia is occasionally reported in patients with other autoimmune illnesses, most commonly systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and ulcerative colitis [1]
Summary
Autoimmune hemolytic anemia is occasionally reported in patients with other autoimmune illnesses, most commonly systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and ulcerative colitis [1]. Case presentation A 40-year-old Caucasian American man with reactive arthritis, Graves’ disease, type 2 diabetes mellitus, mitral valve prolapse, and Gilbert’s disease was admitted with one month of progressive jaundice, fatigue, lightheadedness, and exertional dyspnea. He described dark urine (“the color of raspberry iced tea”) and dark brown to black stools. He had stopped the pioglitazone and metformin more than one month prior to admission (before the onset of jaundice) on the advice of an endocrinologist He had been diagnosed with reactive arthritis about 10 years before admission, and had been treated with etanercept for the previous 8 years. The prednisone was tapered off over 3 months with continued stable hemoglobin levels and no evidence of recurrent hemolysis
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