Subacute cutaneous lupus erythematosus associated with Hodgkin's disease

Summary Simultaneous occurrence of subacute cutaneous lupus erythematosus and malignancy has rarely been reported. We report the first case of subacute cutaneous lupus erythematosus associated with Hodgkin's disease. Although our case doesnot fulfill the criteria of paraneoplastic process, a relationship between the two disorders might be suggested by their simultaneous occurrence and in view of the cases of disseminated lupus erythematosus associated with lymphoma reported so far. The different hypotheses are discussed.     

Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy

Photosensitive eruptions with clinical and histologic features of subacute cutaneous lupus erythematosus and antibodies to SS-A(Ro) antigen occurred in five patients taking hydrochlorothiazide. After drug therapy was discontinued, the eruptions cleared. In one patient anti-SS-A antibodies disappeared after discontinuation of thiazide, and in another rechallenge with hydrochlorothiazide produced an acute dermatitis with a photodistribution. These eruptions may represent a new type of photosensitive drug reaction in which the photoactive drug may be synergistic with anti-SS-A antibody in producing cutaneous lesions of photosensitive subacute cutaneous lupus erythematosus.     

Thymoma associated with pancytopenia and Hashimoto's thyroiditis

Described herein is a twenty year old woman with Hashimoto's thyroiditis in whom thymoma and pancytopenia developed, an association not previously reported. This case represents another example of the relation of thymoma to disorders assumed to be secondary to an autoimmune process.     

Encephalopathy associated with Hashimoto's thyroiditis: an additional case

A 35-year-old female with a history of Hashimoto's thyroiditis (HT) presented with episodic dysphasia and a burst of axial jerks with abdominal muscle contraction and asymmetric blepharospasm as manifestations of encephalopathy associated with HT. Brain magnetic resonance imaging (MRI) showed scattered supratentorial white matter hyperintense T2 foci. Brain single photon emission computerized tomography (SPECT) demonstrated a cortical hypoperfusion in the upper frontal and parietal areas. Corticosteroid therapy induced a rapid improvement of the clinical picture.     

Riedel's thyroiditis associated with Hashimoto's thyroiditis, hypoparathyroidism, and retroperitoneal fibrosis.

A patient with Riedel's struma (invasive fibrous thyroiditis) with hypothyroidism, hypoparathyroidism, and retroperitoneal fibrosis is reported. This disorder appeared to emanate from Hashimoto's thyroiditis in this case. The possible relationship of the two entities is discussed.     

Anti-triiodothyronine antibodies in patients with rheumatoid arthritis associated with Hashimoto's thyroiditis

Anti-triiodothyronine antibody was found in a case of rheumatoid arthritis associated with Hashimoto's thyroiditis. The patient was a 40 year-old woman who had complained of polyarthralgia, joint-swelling and stiffness for seven years. She had a rheumatoid nodule and showed a positive RA test. Radiographic changes of hands and wrists showed osteoporosis, erosions and narrowing of joint space. Nonsteroidal anti-inflammatory drugs had been used for seven years. The diagnosis of Hashimoto's thyroiditis had been made by open biopsy of the thyroid gland seven years before. Serum T4, TSH, TBG, free T4, free T3 and r-T3 were all normal. On the other hand, serum T3 level was almost unmeasurable by radioimmunoassay. Binding of 125I-T3 to the patient's serum was studied by using polyethylene glycol (PEG) and column chromatography. By using the PEG method, the binding of 125I-T3 to the patient's serum was tenfold compared to control serum. Sephadex G-25 column chromatography (0.9 X 1.5 cm) of 125I-T3 with the patient's serum in the presence of 0.1% ANS showed an early radioactive peak, while control serum did not show an early peak. In the next experiments, the patient's serum was labelled with 125I-T3, mixed with human anti-IgG, IgM, IgA, lambda, kappa, incubated at 4 degrees C for 20 hours and centrifuged for 20 min. Strong binding to the anti-IgG and anti-lambda was detected. The presence of this abnormal T3-binding globulin in the patient's serum may have produced an undetectable T3 level.     

Anti-bovine thyrotropin autoantibodies in patients with Hashimoto's thyroiditis, subacute thyroiditis, and systemic lupus erythematosus

We report four cases found to have anti-bovine thyrotropin (bTSH) antibodies, two with Hashimoto's thyroiditis and the other two, each with subacute thyroiditis and systemic lupus erythematosus (SLE). The unusually high negative titers of anti-TSH receptor antibodies (Case no. 1, -43.1%; Case no. 2, -34.9%; Case no. 3, -55.2%; Case no. 4, -59.9%) led to the incidental finding of the presence of anti-bovine (bTSH) antibodies in each patient. Case no. 1 was diagnosed to have Hashimoto's thyroiditis and was treated with L-thyroxine (L-T4). With the treatment, serum free T4 (FT4)normalized with a decline in the serum TSH concentration. The other patient diagnosed to have Hashimoto's thyroiditis (Case no. 2) remained euthyroid even without supplemental thyroid hormone therapy and the serum concentrations of FT4 and TSH stayed within the normal range. The third is a case of subacute thyroiditis (Case no. 3) with a typical clinical course of the disease. She had the anti-bTSH antibodies on her first outpatient visit. Serial examination of her sera disclosed the antibody titers to be on the same range over the 28 months after the onset of the symptoms. The fourth is a patient with SLE who had been treated with steroid (alternative day therapy of 40 mg/day prednisolone). Titers of the anti-bTSH antibodies spontaneously declined to the negative level 5 months later. None of the four cases had antibodies against human TSH alpha-subunit of bovine LH and alpha-subunit of bovine FSH.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hashimoto's thyroiditis and Graves' disease associated with retroperitoneal fibrosis.

Retroperitoneal fibrosis is a rare disease of uncertain pathogenesis. However, its possible association with several immunopathologic conditions, the possibility of systemic involvement by the fibrous process, the presence of various autoantibodies, and the frequent response to immunosuppressive treatment all support an autoimmune pathogenesis. Riedel's thyroiditis is a rare disease the pathogenesis of which is also thought to be immune-mediated based on its optimal response to steroids; Riedel's thyroiditis is also frequently reported in association with retroperitoneal fibrosis. We describe here two cases of autoimmune thyroid disease associated with retroperitoneal fibrosis, the first with features of primary myxedema, the second of primary thyrotoxicosis. Histology of retroperitoneal fibrosis is documented and it is compatible with an immunopathologic condition. Thus, these two cases add further support to the hypothesis of an autoimmune pathogenesis of retroperitoneal fibrosis and indicate the importance of carefully monitoring for the development of other autoimmune disorders, i.e., of the thyroid gland, in patients with retroperitoneal fibrosis.     

Subacute cutaneous lupus erythematosus in a patient with rheumatoid arthritis

A 51-year woman with a seropositive rheumatoid arthritis (RA) developed antiLa/SSB antibodies and erythematosquamous lesions on her upper back. The histological diagnosis was subacute cutaneous lupus erythematosus (SCLE) (papulosquamous form). There was no indication or a drug-induced SCLE. The concurrence of RA and SCLE seems to be rare. We review the clinical, serologic and immunogenetic features in these patients with coexistent RA and SCLE.     

亚急性甲状腺炎

亚急性甲状腺炎是以短暂疼痛的破坏性甲状腺组织损伤伴全身炎性反应为特征,是最常见的甲状腺疼痛疾病.放射性痛和转移性痛为其特征.甲状腺毒症阶段甲状腺激素升高和甲状腺摄碘率降低的双向分离现象是其重要特点.亚急性甲状腺炎在诊断困难时可依靠甲状腺针吸细胞学检查明确诊断.在甲状腺毒症阶段为对症治疗,甲状腺功能减退阶段视病情需要短期、小剂量补充甲状腺激素,而永久性甲状腺功能减退需终身替代治疗.甲状腺功能恢复正常后需继续随访.     

亚急性甲状腺炎

亚急性甲状腺炎是以短暂疼痛的破坏性甲状腺组织损伤伴全身炎性反应为特征,是最常见的甲状腺疼痛疾病。放射性痛和转移性痛为其特征。甲状腺毒症阶段甲状腺激素升高和甲状腺摄碘率降低的舣向分离现象是其重要特点。亚急性甲状腺炎在诊断困难时可依靠甲状腺针吸细胞学检查明确诊断：在甲状腺毒症阶段为对症治疗,甲状腺功能减退阶段视病情需要短期、小剂量补充甲状腺激素,而永久性甲状腺功能减退需终身替代治疗。甲状腺功能恢复正常后需继续随访.     

Subacute thyroiditis associated with positive antibodies to the Epstein-Barr virus

Subacute thyroiditis is an inflammatory disorder of the thyroid caused probably by viruses. It is clinically characterized by the presence of anterior cervical pain and/or painful goiter, and rarely as fever of unknown origin or as prolonged fever syndrome. We report a case of a 49-year-old female admitted to the hospital because of fever during last month, leukocytosis and accelerated erythrocyte sedimentation rate. Following observation, slight tenderness over the thyroid gland and signs of hyperthyroidism occurred. After the laboratory studies, low thyroidal radioactive iodine uptake and fine-needle aspiration cytology (FNAC) of thyroid, she was diagnosed of subacute thyroiditis with hyperthyroidism. We believe that the etiologic agent was the Epstein-Barr virus because heterophile and Epstein-Barr virus-specific antibodies were positive. The patient was treated with acetaminophen (1.500 mg/day) with prompt and complete resolution of the clinical and laboratory abnormalities. There has been no recurrence of the disease during a 1 year follow-up.     

External ophthalmoplegia associated with Hashimoto's thyroiditis and recovered on corticosteroid treatment

Five-year follow-up of a young male patient is presented. Total external ophthalmoplegia developed 1 week after an upper respiratory tract infection. After 3 years of the course, hyperthyreosis and clinical signs of thyroid-associated ophthalmopathy occurred. Hashimoto's thyroiditis and ultrastructural signs of mitochondrial damage of striated muscle were found by histological investigations. The paresis of the external ocular muscles recovered after long-term corticosteroid treatment. On the basis of clinical symptoms and histological results, the authors supposed that an immunological reaction had caused mitochondrial damage in the striated muscles, which also resulted in thyroiditis. This case history points that autoimmune mechanism more frequently might participate in the pathogenesis of chronic external ophthalmoplegia, and the symptoms might precede organ-specific or perhaps systemic autoimmune disorders.