Poliautoinmunidad, un reto diagnóstico: reporte de caso

Abstract

Background: Autoimmune diseases represent a group of pathological conditions in which the immune system attacks the body's components, causing damage to various organs and tissues. These conditions affect 4% of the global population, predominantly women, and are influenced by genetic and environmental factors contributing to the loss of immune tolerance and subsequent tissue damage. Polyautoimmunity is characterized by the coexistence of multiple autoimmune diseases in the same individual, complicating its diagnosis and treatment due to the etiology that is not yet fully understood. Case presentation: A 29-year-old female patient presents with polyarthralgia, fever, and synovitis, initially diagnosed with rheumatoid arthritis. She subsequently develops systemic lupus erythematosus, presenting with a malar rash, subacute cutaneous lupus erythematosus, myalgia, arthralgia, and lupus glomerulonephritis. She evolves into a clinical picture consistent with Sjögren's syndrome, with xerostomia, xerophthalmia, and dry keratoconjunctivitis. Additionally, she presents with synovitis and cartilage damage in the left knee, treated with arthroscopy, and a lesion in the right ankle characterized by osteophytes and soft tissue edema. Eventually, secondary Raynaud's phenomenon is diagnosed, evidenced by triphasic color changes in the fingers upon exposure to cold. Due to the complexity of the condition, the patient requires multidisciplinary management, including immunosuppressants, monoclonal antibodies, and steroids. Conclusion: This case highlights the rarity of presenting with four concomitant autoimmune diseases, which pose diagnostic challenges, severe complications, and a complex response to multidisciplinary treatment.