A 20-year-old woman with Hashimoto's thyroiditis and Evans' syndrome.
A 20-year-old woman with Hashimoto's thyroiditis and Evans' syndrome.
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DOI：
10.3349/ymj.2006.47.3.432
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发表时间：
2006-06-30
影响因子：
2.4
通讯作者：
Park MH
中科院分区：
文献类型：
--
作者：
Kang MY;Hahm JR;Jung TS;Lee GW;Kim DR;Park MH
在此，我们报告一名 20 岁女性患者的病例，该患者先前被诊断患有桥本甲状腺炎和明显甲状腺功能减退症，并已服用合成甲状腺素（100 µg/天）八个月。她出现间歇性头晕和全身无力，被诊断患有严重的自身免疫性溶血性贫血（AIHA）。我们给予泼尼松龙治疗并继续施用合成甲状腺素。两年零五个月后，她患上了特发性血小板减少性紫癜（ITP），并被诊断为埃文斯综合征。此后，由于她的自身免疫性溶血性贫血难以治愈并且依赖类固醇治疗，因此进行了腹腔镜脾切除术。患者的HLA基因型为HLA-A*020101/A*2602、HLA-B*270502/B*5401、HLA-Cw*0102/Cw*020202、HLA-DRB1*0404/DRB1*0405、HLA-DQB1*0302/DQB1*0401。桥本甲状腺炎常与其他非内分泌自身免疫性疾病相关，抗甲状腺抗体常见于埃文斯综合征（AIHA 和 ITP 并存）。然而，尚无明显甲状腺功能减退症和桥本甲状腺炎患者发生埃文斯综合征的报道。该病例表明，三种自身免疫性疾病（AIHA、ITP 和桥本甲状腺炎）在发病机制上可能具有共同的免疫遗传学途径。
Here we report the case of a 20-year-old female patient previously diagnosed with Hashimoto's thyroiditis and overt hypothyroidism, and who had been taking synthetic thyroxine (100 µg/day) for eight months. She experienced intermittent dizziness and generalized weakness, and was diagnosed as having severe autoimmune hemolytic anemia (AIHA). We prescribed prednisolone treatment and continued synthetic thyroxine administration. Two years and five months later, she developed idiopathic thrombocytopenic purpura (ITP) and was diagnosed with Evans' syndrome. Thereafter, laparoscopic splenectomy was performed because her autoimmune hemolytic anemia was refractory and dependent on steroid therapy. The HLA genotypes of the patient were HLA-A*020101/A*2602, HLA-B*270502/B*5401, HLA-Cw*0102/Cw*020202, HLA-DRB1*0404/DRB1*0405, and HLA-DQB1*0302/DQB1*0401. Hashimoto's thyroiditis is often associated with other nonendocrine autoimmune diseases, and antithyroid antibodies are frequently observed in Evans' syndrome (coexistence of AIHA and ITP). However, there is no report of Evans' syndrome developing in patients with overt hypothyroidism and Hashimoto's thyroiditis. This case suggests that three autoimmune diseases (AIHA, ITP, and Hashimoto's thyroiditis) might share a common immunogenetic pathway in pathogenesis.
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影响因子：
5.4
作者：
LIO, S;ALBIN, M;DARMIENTO, M
通讯作者：
DARMIENTO, M
影响因子：
2.4
作者：
Kie, JH;Cho, MS;Yang, WI
通讯作者：
Yang, WI
影响因子：
--
作者：
Park, MH;Kim, HS;Kang, SJ
通讯作者：
Kang, SJ
影响因子：
--
作者：
EVANS, RS;TAKAHASHI, K;LIU, CK
通讯作者：
LIU, CK
影响因子：
1.2
作者：
Yashiro, M;Nagoshi, H;Saito, N
通讯作者：
Saito, N