A Case of Autoimmune Polyglandular Syndrome Type III Diagnosed Based on the Detection of Pernicious Anemia Associated with Type 1 Diabetes Mellitus and Chronic Thyroiditis

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  • 1型糖尿病と慢性甲状腺炎に悪性貧血を合併した自己免疫性多内分泌腺症候群（APS）3型の1症例
  • ショウレイ ホウコク 1ガタ トウニョウビョウ ト マンセイ コウジョウセンエン ニ アクセイ ヒンケツ オ ガッペイ シタ ジコ メンエキセイ タナイブンピツセン ショウコウグン(APS)3ガタ ノ 1 ショウレイ

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A 74-year-old woman was admitted with general fatigue and severe anorexia. She had been treated with levothyroxine sodium hydrate since 53 years of age. At 71 years of age, she was diagnosed with type 1 diabetes mellitus and soon after received insulin treatment. On the current admission, her laboratory data showed severe anemia, with an Hb level of 5.9 g/dl. Subsequently, a low serum vitamin B12 level, findings of erythroblastic hyperplasia with megaloblasts in the bone marrow and positive tests for intrinsic factor antibodies led to a diagnosis of pernicious anemia. Based on the presence of the combination of these three autoimmune diseases (chronic thyroiditis, type 1 diabetes mellitus and pernicious anemia without idiopathic adrenal insufficiency), the patient was diagnosed with autoimmune polyglandular syndrome type III. The pernicious anemia was gradually attenuated by intramuscular injections of vitamin B12. Notably, it was very curious that the protective DR-DQ haplotype for type 1 diabetes was identified. We herein reported a rare case of autoimmune polyglandular syndrome type III. Physicians should therefore pay attention to the possibility for the development of other potentially associated autoimmune diseases during follow-up in type 1 diabetes mellitus patients.

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