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Correspondence: Dingyang He, MD, Department of Dermatology, First Affiliated Hospital, Sun Yat-Sen University. 58 Zhongshan Road II, Guangzhou 510080, China.
A 43-year-old female patient presented with a 6-year history of increased appetite,
weight loss, heat intolerance, sweating, tremor and goiter, when she was diagnosed
with hyperthyroidism and received methimazole (Tapazole). This patient developed vitiligo,
3 years before ( Figure A, on the fingers), and halo nevus (Figure B, on the chest), involving face,
limbs and trunk. She experienced malar erythema, 8 months before (Figure C, on bilateral
cheeks, mainly involving the right cheek) and photosensitivity, with no arthritis
or oral ulcers. Laboratory tests showed anemia and high titers of autoimmune antibodies,
including anti–double-stranded DNA, antinuclear, antinucleosome, antithyroid peroxidase
and antithyroglobulin antibodies, without evident proteinuria. However, the test for
antihistone antibody showed negative result. A biopsy specimen from the erythematous
lesion on the cheek showed basal cell liquefaction degeneration and lymphocytic infiltration
in the superficial layer of dermis (Figure D, hematoxylin and eosin; original magnification,
×100 and ×400). Immunofluorescence of epidermal basement membrane demonstrated deposits
of IgG, IgA, IgM and C3, consistent with the changes in lupus erythematosus. Thus,
the diagnosis of autoimmune polyglandular syndrome type 3 was confirmed. The malar
erythema, vitiligo and lupus disease activity were controlled with methylprednisolone,
hydroxychloroquine and topical tacrolimus treatment.
