The kaleidoscope of autoimmunity: A report of 10 cases of multiple autoimmune syndrome

Dear Sir, Multiple autoimmune syndrome has been defined as the coexistence of at least three autoimmune disorders in a single patient.[1] Dermatological autoimmune disorders, especially vitiligo, take a special seat in the setting of multiple autoimmune syndrome.[2] There is strong evidence to suggest that the various autoimmune disorders have a common origin and share similar pathophysiological mechanisms. Therefore, the presence of one autoimmune disorder in an individual makes him/her susceptible to the development of other autoimmune disorders.[3] Herein, we report 10 cases of multiple autoimmune syndrome that presented to the dermatology department of our hospital. The patients’ details are shown in [Table 1]. Females made up majority of the cases in our series with seven patients while there were only three male patients. The age of the patients ranged from 19 to 60 years. Seven patients had three autoimmune disorders, two patients had four, and one patient had five coexisting autoimmune disorders. Autoimmune thyroid disease was the most common disorder in our case series which was present in seven patients. The diagnoses of vitiligo, psoriasis, alopecia areata, and lichen planus were confirmed with clinical examination and dermoscopy along with histopathological examination. In addition to these, specific antibody testing was carried out for systemic sclerosis, systemic lupus erythematosus, pemphigus vulgaris, and bullous pemphigoid. Triiodothyronine, tetraiodothyronine, thyroid-stimulating hormone, and antithyroid peroxidase antibody levels were carried out for autoimmune thyroid disease while fasting blood glucose, serum insulin levels, and serum C-peptide levels were measured for type 1 diabetes mellitus. The diagnosis of rheumatoid arthritis was based on clinical, radiological, and immunological testing. Disorders with an autoimmune pathogenesis occur with increased frequency in patients already suffering from another autoimmune disease.[4] The term polyautoimmunity has been proposed for this association of autoimmune disorders. This term also encompasses the probable common origin of these disorders.[5] Multiple autoimmune syndrome showcases the kaleidoscope of autoimmunity with at least three autoimmune disorders being present in a single patient. The presence of one autoimmune disease should alert one to watch for presence or subsequent development of another one. To sum up, this study indicates that autoimmune hypothyroidism, type 1 diabetes mellitus, and rheumatoid arthritis are the most common systemic associations of the autoimmune dermatological disorders. Hence, a patient presenting with features of skin autoimmunity must be investigated for these conditions. Declaration of patient consent Patient’s consent not required as patient’s identity is not disclosed or compromised. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest

Angiolymphoid hyperplasia with eosinophilia: A report of a rare entity in an elderly male

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign proliferation of blood vessels of uncertain etiology. It primarily affects the head-and-neck region. Histologically, it is characterized by the prominent proliferation of plump endothelial cells, and accompanying eosinophilic and lymphocytic infiltration. Herein, we report the case of ALHE in a 65-year-old male

Hyperon Polarization along the Beam Direction Relative to the Second and Third Harmonic Event Planes in Isobar Collisions at <math display="inline"><mrow><msqrt><mrow><msub><mrow><mi>s</mi></mrow><mrow><mi>N</mi><mi>N</mi></mrow></msub></mrow></msqrt><mo>=</mo><mn>200</mn><mtext> </mtext><mtext> </mtext><mi>GeV</mi></mrow></math>

The polarization of Λ and Λ¯ hyperons along the beam direction has been measured relative to the second and third harmonic event planes in isobar Ru+Ru and Zr+Zr collisions at sNN=200  GeV. This is the first experimental evidence of the hyperon polarization by the triangular flow originating from the initial density fluctuations. The amplitudes of the sine modulation for the second and third harmonic results are comparable in magnitude, increase from central to peripheral collisions, and show a mild pT dependence. The azimuthal angle dependence of the polarization follows the vorticity pattern expected due to elliptic and triangular anisotropic flow, and qualitatively disagrees with most hydrodynamic model calculations based on thermal vorticity and shear induced contributions. The model results based on one of existing implementations of the shear contribution lead to a correct azimuthal angle dependence, but predict centrality and pT dependence that still disagree with experimental measurements. Thus, our results provide stringent constraints on the thermal vorticity and shear-induced contributions to hyperon polarization. Comparison to previous measurements at RHIC and the LHC for the second-order harmonic results shows little dependence on the collision system size and collision energy.The polarization of $\Lambda$ and $\bar{\Lambda}$ hyperons along the beam direction has been measured relative to the second and third harmonic event planes in isobar Ru+Ru and Zr+Zr collisions at $\sqrt{s_{NN}}$ = 200 GeV. This is the first experimental evidence of the hyperon polarization by the triangular flow originating from the initial density fluctuations. The amplitudes of the sine modulation for the second and third harmonic results are comparable in magnitude, increase from central to peripheral collisions, and show a mild $p_T$ dependence. The azimuthal angle dependence of the polarization follows the vorticity pattern expected due to elliptic and triangular anisotropic flow, and qualitatively disagree with most hydrodynamic model calculations based on thermal vorticity and shear induced contributions. The model results based on one of existing implementations of the shear contribution lead to a correct azimuthal angle dependence, but predict centrality and $p_T$ dependence that still disagree with experimental measurements. Thus, our results provide stringent constraints on the thermal vorticity and shear-induced contributions to hyperon polarization. Comparison to previous measurements at RHIC and the LHC for the second-order harmonic results shows little dependence on the collision system size and collision energy