58ESPE hypothyroidismthe same child.SLE in and firstwould bethe This to case report autoimmunethe tetrad TIDM,CD, of reported once tochildprior ina thebest ofourknowledge [ Butof theTIDM theassociation common tothe diseases both[ leukocyteDR (HLA) due thehuman antigenis probably incidence.Thishigh has a between and Celiacdiseasean associationTIDM (CD) and etiopathological viral infectionsare and Genetic themain autoimmunity predisposition, cases reportedliterature in the occurrence and in childrenis even lesser [ to report thedata There incidenceofthenot much same. are very few of these However type [ been associated with higher anti Type being oneofthem. organsand Systemic lupus were sent, the reports for which came back strongly positive. conditions, anti her persisting fever and rash, and co existing positive autoimmune Her blood and urine cultures came back with nopathogenic growth. Due to started on tab which The thyroid function tests, anti TPO and anti treatment. had influenza wasand treated with high grade remitting fever, her throat swab was positive for antibiotics, for which shewas admitted and evaluated. She continued to have grade and persisted for three weeksnot responding to oral anti and managed symptomatically. However the fever continued to beofhigh palms and sole) and face. Thiswas presumed to be aviral developed high She continued to befollowed up regularly for the next three years. She then parameters were within normal limits. Her hemoglobin at the time was and 12.9gm/dl rests ofthe hematological regularly followed for her thyroid functions. (positive) but her TSH and Free T4 were within normal limits and hence were advised a gluten free diet. Her anti thyroid increased intra which was followed upwith a duodenal biopsy showing anti on Insulin A 9year P3-319 1,2 relating to this work. conflicts ofinterest includingin anymatters, financial issues, Conflict of Interest ]. - pancytopenia tissue cameback - old girl, was with diagnosed TIDMwith Hba1c wasof 9.3,she started - is often associated with other autoimmune conditions, diabetesisother conditions,mellitus oftenassociatedwithautoimmune insulin antibodies, chronic inflammation and chronic use ofsteroidsand chronic inflammationantibodies, insulin degludec transglutaminase 1 erythematosus diabetes mellitus (TIDM) developing in SLE is very SLE isvery rare developing in there diabetesmellitus(TIDM) and is factorsthe pathogenesisoftype implicatedin Rakhi Jain, Indrapal singh Kochar Diabetes and insulin thyroxine - - - epithelial cells, confirming wasthe ofCDand diagnosis Hypothyroidism complicating type grade fever and macular rashes on her hand, legs(including nuclear nuclear antibodies (ANA), anti double stranded ( DNA strongly positive and low free T4 and high TSH, she was , which continued to persist despite the antibiotic hyperinsulinemia CASE REPORT and and 2 Systemic lupus Study Design Introduction diabetes complicating SLE has been reportedSLE has adults,diabetescomplicatingin glulisine 25ug once aday. : 4 (SLE) is an autoimmune disease involving multiplediseaseautoimmuneis involving an (SLE) The authors havenorealorperceived The authors andCDsubsequently ]. antibodies ( ceftriaxone and and was maintaining normal sugars. Her and insulin resistanceinsulinto diabetes leadingand Rakhi AtTG Jain, peroxidase according to sensitivity. She also thyroglobulin ) waspositive developing SLE has only been SLE has developing Inderpal 3 - DQ 5 2 ]. (TPO)was >573IU/ml and DR and 1 Singh villus diabetesmellitus exanthem a rare tetrad. were repeated hemophilus – 4 101 RU/ML, 101 RU/ML, erythematosus atrophy and Kochar - - DQ pyretic and 1,3 8 ]. that is that . initially Indraprastha ds DNA) DNA) IgA DOI: 10.3252/pso.eu.58ESPE.2019 positive patients developed TIDM[ however thesethe followupof mentioned,of the was whetheranyantibody not thisstudydiseases.In autoimmune by a studyIn developingtoSLE due non higher riskmay beata islet antiof (ICA) and cellantibodies(IAA) antibodies insulin SLE isvery rare, the associationofTIDMand have anti childrenTIDMThough with wasand biopsyconfirmed for[ CD (AEA), She alsotestednormal.for positive systemicand scleroderma.she testedfor antiEven thoughpositive H to havereportedallThe onlyotherstudytogether thethreeconditions was by [ a singlechild notSLE was of diabetesand The etiology durationwhere flareand died duetoSLE up. one child of diabeticonly childrenbut populationin this enrolledtheirThey reported andexistingconditionsevaluated. co etby Kota study al, an Indian In evendiabetes though veryis mellitus a rare association[ develop two,SLE maythreeor with sometimeseven disorders, four autoimmunebut as has beenreportedashighmanifestingtogether. thatconditions It Geneticallypredisposedare knownassociated tohave patientsautoimmune conditionsin thesamepatient or even progressive development. There needs to beanawarenesstheco about existence of autoimmuneadditionaldisorders and SLE. TIDMother than cases of thisof theseassociationreported inand onlyonecasehad children, The numberofcases T with ➢ ➢ ➢ 8. 7. 6. 5. 4. 3. 2. 1. References é Apollo Hospital New Delhi, India. laZeglaoui autoimmune diseases. Diabetesautoimmunediseases.Res Harrop type Heras mortality.Rheum Ann and referencedamage with to of patients cohort multiethnica in diseases autoimmune S, Chambers, girl.RheumatolInt lupussystemic disease, Zeglaoui associateddisorders. MJ, Redondo typeinconditions Kota SK, erythematosus Lidar 2008 lupus S., Chambers, S., Cortes, screened for, asthey can develop it later. The autoimmune diseasesknown to occur together shouldalways be damage. However it should be borne in mind both as together can result in organ together is rare. TIDM and SLE are both autoimmune processes, but their association IgA , M. et al.Anti M. , ; 1 erythematosus 977 P, diabetes.DiabetesRes antireticulin M, CaudwellJ, M, Meher Mantzioros H, mentioned.But – Harrop in a 980 3 Landolsi : ]. Charman Eisenbarth . . Lupus . 15 LK, ( yr old girl with TIDM since of girl withyr oldtheage TIDM 1 , they evaluatedthepresence , other of IAAwithin patients Poster Poster 2010 - Jammula insulin antibodies and the natural autoimmune response in systemic lupussystemicin response autoimmunenatural the and antibodies insulin diabetesmellituspatients. Diabetes H, M, – Diabetologia , Celiac and (ARA) and analysis of the analysis Dis Stojanovski , SC, , 10 Mankai ) erythematosus Mendrinos Jerónimo presented GS. Genetic control of autoimmunity in typein of autoimmunitycontrol GS. Genetic 30:793 , - DISCUSSION 2007 2001 organ specific 1 there all togetherin were CD no casesTIDM, withSLEand CONCLUSION Rahman DM and SLE arevery and DM few.There have beenonlyfour 1 S, Kota SK, S, ClinPract ; A, ; – 260 66 81 795 Ghedira IgA , A. & Isenberg, D. Diabetes mellitus complicating systemicmellituscomplicating Diabetes D. & Isenberg, A. , at: 5 C, Colman PG ( PG C, Colman 8 2002 diabetes: : – D, , A, Isenberg, DA. Develop DA. Isenberg,A, , ]. ]. 1123 10 86 ClinPract IgA children and adolescents with TIDM were adolescentschildrenTIDM with and Heras anti UCL lupus cohort and reviewliterature. ofthe and cohort UCL lupus 90 and systemic scleroderma in a inscleroderma systemic and ; patients with SLE were withpatients forIAA,positive Modi 45:605 and – : e : 1127 I, - autoantibodies tissue Bouajina 40 V, IgGantigliadin 18 KD ( - Hatzopoulos – . 42 : 22 3 1992 107 2012 . transglutaminase childrenSLE were with reported, . - E. Type E. 112 ) Insulin ) ) Clinicalprofile ofcoexisting ) MetabSyndr . 6 A, et al.( A, (ANA, anti(ANA, ]. 6 1 - (AGA), yrs, whodeveloped SLE 2 autoantibodies ment celiac diabetesmellitus, or moreauto immune of additional 2010 6 1 15 IgA : antibodies ( antibodies diabetesand 7 70 - - - % incidence ofCD dsDNA year TPO, TSH was TPO, TSH ) - 30 antiendomysial 76 Autoantibodies % of patients% of . - in patients with patientsin old ) [ ) 7 ]. Lupus Lupus AtTG - ), 17 in ,