The Hidden Link: Chronicle of auto-immune disorders

Objectives : The aim of this case report is to describe a rare association of concomitant pernicious anemia and autoimmune hepatitis type II in a pediatric patient, highlighting diagnostic challenges and the importance of comprehensive autoimmune screening. Material and methods : A 15-year-old male patient presented with fatigue, pallor, weight loss, night sweats, headaches and spontaneous bruising. Initial investigations included a complete blood count and basic biochemical profile. Further analyses comprised cytology, vitamin B12, folate, thyroid function, viral serology and immunological screening by indirect immunofluorescence and dot-blot assays for autoantibodies. Results : Laboratory investigations revealed pancytopenia, macrocytic aregenerative anemia, elevated liver enzymes and biochemical evidence of intravascular hemolysis. Bone marrow analysis demonstrated erythroblastosis. Peripheral smear showed anisopoikylocytosis, hypersegmented neutrophils and schizocytes. The detection of anti-intrinsic factor and anti-parietal cell autoantibodies confirmed pernicious anemia, while strongly positive anti-LKM1 antibodies supported the diagnosis of autoimmune hepatitis type II. No infectious or hematological malignancies were identified. The coexistance of these two distinct autoimmune disorders accounted for the hematological and hepatic manifestations. Conclusion : This case underlines the necessity of considering overlapping autoimmune conditions. The rare association of pernicious anemia and autoimmune hepatitis type II emphasizes the value of autoimmune screening in atypical clinical presentations. Early recognition enables targeted treatment (vitamin B12 supplementation and immunosuppressive therapy) and careful monitoring for autoimmune diseases and long-term complications.