Ann Dermatol.  2017 Dec;29(6):782-785. 10.5021/ad.2017.29.6.782.

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

Affiliations
  • 1Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. ylpark@schmc.ac.kr
  • 2Uljin Medical Center, Uljin, Korea.

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.

Keyword

Autoimmune diseases; Crohn disease; Psoriasis; Vitiligo

MeSH Terms

Autoimmune Diseases
Crohn Disease*
Humans
Lichen Planus, Oral
Necrosis
Psoriasis*
Vitiligo*

Figure

  • 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.


Reference

1. Humbert P, Dupond JL, Vuitton D, Agache P. Dermatological autoimmune diseases and the multiple autoimmune syndromes. Acta Derm Venereol Suppl (Stockh). 1989; 148:1–8.
2. Masood S, Sajid S, Jafferani A, Tabassum S, Ansar S. Multiple autoimmune syndromes associated with psoriasis: a rare clinical presentation. Oman Med J. 2014; 29:130–131.
Article
3. Anaya JM, Castiblanco J, Rojas-Villarraga A, Pineda-Tamayo R, Levy RA, Gómez-Puerta J, et al. The multiple autoimmune syndromes. A clue for the autoimmune tautology. Clin Rev Allergy Immunol. 2012; 43:256–264.
Article
4. Wilson JC, Furlano RI, Jick SS, Meier CR. Inflammatory bowel disease and the risk of autoimmune diseases. J Crohns Colitis. 2016; 10:186–193.
Article
5. Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Buchar). 2010; 5:132–134.
6. Humbert P, Dupond JL. Multiple autoimmune syndromes. Ann Med Interne (Paris). 1988; 139:159–168.
7. Pasić A, Ljubojević S, Lipozencić J, Marinović B, Loncarić D. Coexistence of psoriasis vulgaris, bullous pemphigoid and vitiligo: a case report. J Eur Acad Dermatol Venereol. 2002; 16:426–427.
Article
8. Topal F, Senel E, Akbulut S, Topal F, Dölek Y. A new combination of multiple autoimmune syndrome? Coexistence of vitiligo, autoimmune thyroid disease and ulcerative colitis. Dermatol Reports. 2011; 3:e19.
Article
9. Barthel C, Biedermann L, Frei P, Vavricka SR, Kündig T, Fried M, et al. Induction or exacerbation of psoriasis in patients with Crohn's disease under treatment with anti-TNF antibodies. Digestion. 2014; 89:209–215.
Article
10. Lee H, Lee MH, Lee DY, Kang HY, Kim KH, Choi GS, et al. Prevalence of vitiligo and associated comorbidities in Korea. Yonsei Med J. 2015; 56:719–725.
Article
11. Al-Mamari F, Al-Shirawi A, Banodkar D, Al-Hashmi S, Al-Yahyaae F, Varghese M, et al. HLA Antigens in Omani Psoriasis Vulgaris Patients. Oman Med J. 2009; 24:27–29.
12. Santos G, Sousa L. Syndrome in question. Multiple autoimmune syndrome. An Bras Dermatol. 2014; 89:361–362.
13. Kim M, Choi KH, Hwang SW, Lee YB, Park HJ, Bae JM. Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study. J Am Acad Dermatol. 2017; 76:40–48.
Article
14. Smith RL, Warren RB, Eyre S, Ho P, Ke X, Young HS, et al. Polymorphisms in the IL-12beta and IL-23R genes are associated with psoriasis of early onset in a UK cohort. J Invest Dermatol. 2008; 128:1325–1327.
Article
15. Kim SW, Kim ES, Moon CM, Park JJ, Kim TI, Kim WH, et al. Genetic polymorphisms of IL-23R and IL-17A and novel insights into their associations with inflammatory bowel disease. Gut. 2011; 60:1527–1536.
Article
16. Ismail WA, Al-Enzy SA, Alsurayei SA, Ismail AE. Vitiligo in a patient receiving infliximab for refractory ulcerative colitis. Arab J Gastroenterol. 2011; 12:109–111.
Article
17. Posada C, Flórez A, Batalla A, Alcázar JJ, Carpio D. Vitiligo during treatment of Crohn's disease with adalimumab: adverse effect or co-occurrence? Case Rep Dermatol. 2011; 3:28–31.
Article
18. Park JM, Kim HJ, Bae BG, Park YK. A case of concurrent vitiligo and psoriasis. Ann Dermatol. 2009; 21:330–333.
Article
19. Karn D, Kc S. Concurrent vitiligo and psoriasis. Kathmandu Univ Med J (KUMJ). 2012; 10:83–84.
Article
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