Multiple Autoimmune Syndrome with Vitiligo, Autoimmune Thrombocytopenia and Autoimmune Dermoepidermal Bullous Dermatosis

Abstract

Multiple auto-immune syndrome is defined by the coexistence of at least three different autoimmune diseases. Immune genetic predisposition and abnormalities of humeral and cell-mediated immunity seems to be implicated in their genesis. In this observation, we describe a combination of three autoimmune diseases in the same patient namely vitiligo evolving since childhood, autoimmune dermo epidermal bullous dermatosis and autoimmune thrombocytopenia. The discovery of such associations may limit the therapeutic arsenal. And temporal sequence indicates that long-term surveillance of these patients is necessary to watch the occurrence of another autoimmune disease. According to the clinical context and the results of immune histology we retained in our patient the combination of three autoimmune diseases: vitiligo, autoimmune thrombocytopenia with autoimmune bullous derma epidermal dermatitis most probably cicatricle pemphigoid. Epidermolysis bullosa acquisita that looks like cicatricle pemphigoid cannot be ruled out given the lack of examination by immune-microscopy. The patient was initially put on oral corticosteroids at a dose of 1mg / kg / day until normalization of platelet levels. Then treatment with daps one at a dose of 2 mg / kg / day associated with mycofenolate mofetil at a rate of 2g / day was initiated with a clinical and laboratory monitoring. The evolution was marked by the stabilization of the disease and a slight improvement in ocular involvement.