¹Jawaher Saleh Enani, ¹Mohammed A. Omair, ¹Abdulaziz Aljasser, ²Nuha Alrajhi,³Salman Alsaleh

¹Rheumatology Division, Department of Medicine, King Saud University, ²Pulmonary Division, Department of Medicine, King Saud University, ³Rheumatology Division, Department of Medicine, King Faisal Specialist Hospital

Introduction: Multiple autoimmune syndromes (MAS) involves the coexistence of multiple autoimmune disorders due to immune dysregulation pathways and shared genetic polymorphisms. Systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) are connective tissue diseases, with different and unique pathogenesis and antibody profiles. Celiac disease (CD) is an immune-mediated small intestine pathology. the coexistence of SLE and CD, SSc and CD, and SSc and SLE (also known as overlap syndrome) has been reported previously in some case reports.

Method(s): A 21-year-old woman with juvenile SSc and Interstitial lung disease (ILD) was admitted to the hospital in January 2023 with a history of fever and cough with an impression of upper respiratory tract infection. She reported persistent lower abdominal pain,

Result(s): Our patient has a unique presentation of CD and SLE that develops 9 years after the onset of SSc. Patients with a history of one autoimmune disease Have roughly a 25% Chance to acquire an additional type of autoimmune pathogenic disorder. Few case reports discussed the coexistence of CD in SSc patients as well as the association between CD and SLE. The association between SLE and SSc is well-established in literature. Despite these past correlations in case studies, no previous case reports documented the coexistence of SSc, SLE, and CD together.

Conclusion(s): To the best of the author’s knowledge, this case study is the first to report multiple autoimmune syndromes coexisting in a single patient, including SLE, SSc, and CD. The combination fits the criteria of MAS but cannot be classified into any subcategory of the already known MAS types.

This case was reported to highlight the importance of investigating the coexistence of autoimmune syndromes based on clinical presentation, as rare associations can occur