Abstract
Ulcerative colitis, Basedow's disease, dermatomyositis and finally multiple mononeuritis appeared, almost successively within less than 1 year, in a previously healthy 61-year-old woman when she was 53 years old. The diagnosis was confirmed by clinical features and biopsies performed on the colon, skin, muscle and sural nerve. Among the four diseases, multiple mononeuritis of the right upper and left lower limbs has continuously been present, showing some progression, for more than 8 years with added damage to the right trigeminal nerve. Although occlusion of vasa nervorum was suspected as the cause of multiple mononeuritis, evidence of angiitis, which also could link multiple mononeuritis to dermatomyositis, was not obtained from the biopsies. The patient has no diabetes mellitus. On this admission, serum immunoglobulins were normal. Serum CPK which previously showed elevated values was in the normal range, while urinary excretion of myoglobin and creatine was abnormal. Autoimmune processes are assumed in the pathogenesis of ulcerative colitis, Basedow's disease and dermatomyositis. Generally there is a tendency for more than one autoimmune disease to occur in the same individual, but when this happens the association is usually between diseases belonging to only one of the three groups classified by Roitt according to the nature of diseases and autoantibodies. The three disorders mentioned above, of this patient belong to the different groups of the autoimmune diseases. In this point this case is unique. The combination of these three disorders and also with multiple mononeuritis has not ever been reported in the literature.
