Celiac disease (CD) has been found in 2-3% of patients with PSC. There is a known association between Ulcerative Colitis and PSC. Studies show that 2-7.5% of patients with UC develop PSC. The combination of CD, UC, and PSC is even more uncommon. This is a case of a 57-year-old woman with history of UC and PSC who was found to have CD on annual endoscopy. Patient is a 57-year-old Caucasian woman with history of UC/PSC who presented for annual EGD/colonoscopy. She was initially diagnosed with UC by colonoscopy at age 40 after a one-year history of recurrent diarrhea. Since then, she has been managed on Apriso with yearly colonoscopies. At age 46, she was diagnosed with PSC after a cholestatic liver profile prompted ERCP, which revealed focal left intrahepatic ductal stricture. Since then, she has been managed on Actigall and follows up with Hepatology every 6 months. Five years later, she was found to have advanced liver disease secondary to her PSC when ERCP revealed dominant biliary stricture. Two years later, at age 54, she was found to have small proximal esophageal varices on endoscopy, which portended advancement of liver disease with significant portal hypertension. Esophageal varices were controlled with endoscopic ligation. Subsequent endoscopies have been negative for esophageal varices. On her annual EGD, she was found to have duodenal irregularity; subsequent biopsies revealed blunting of villi. She was diagnosed with CD, complicating her PSC and UC. Her CD is currently being managed by gluten-free diet. PSC and UC have a long-standing known association. Both conditions are autoimmune in nature with p-ANCA positivity. Classically, they present together in middle-aged men; their presentation in a woman makes our case unique to begin with. PSC and CD have a less well-known association, most likely due to immunologic connection. However, very few previous case studies have examined association and clinical outcomes between UC and co-existing CD. According to Giovanni et al., IBD could obfuscate the symptoms of CD because they share common symptoms such as weight loss, abdomen pain, and diarrhea. Another prior case series of IBD patients with CD found that 4/5 of these patients with co-existing UC and CD tend to have pancolitis. However, these patients did not have PSC. Thus, our patient with all three conditions co-existing together represents a unique case as there is limited knowledge regarding the course of UC in patients with both PSC and CD.