An uncommon case of primary biliary cirrhosis and Hashimoto thyroiditis followed by the concurrent onset of multiple sclerosis and Sjögren syndrome

A 51-year-old woman with a diagnosis of primary biliary cirrhosis and Hashimoto thyroiditis followed by concurrent onset of multiple sclerosis and Sjögren syndrome for seven years was admitted. The patient was treated with pulse steroid and cyclophosphamide combined with a physical therapy program. This is a case of four autoimmune diseases coexisting in a single patient, a finding which has not previously been described in the literature. This combination of autoimmune diseases should be kept in mind in patients with the relevant symptoms and signs of each to provide early diagnosis and appropriate treatment.