{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:40:06Z","timestamp":1756366806239,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,3,20]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>The coexistence of adrenal failure with either autoimmune thyroid disease and\/or type 1 diabetes is defined as autoimmune polyglandular syndrome (APS) type 2 or Schmidt\u2019s syndrome. Vitiligo, hypergonadotropic hypogonadism, chronic autoimmune hepatitis, alopecia, pernicious anaemia and seronegative arthritis may also be present. We present a case of 45-year-old Indian man with progressive jaundice and asthenia for 3 months. He was also found to have pallor, icterus, dry coarse skin and delayed relaxation of ankle jerk. Investigations showed pancytopaenia with megaloblastic changes due to pernicious anaemia, autoimmune hypothyroidism and autoimmune adrenalitis with evolving adrenal insufficiency. Upper gastrointestinal endoscopy guided biopsy showed evidence of gastric mucosal atrophy. Patient responded well to hydroxocobalamin and thyroxine replacement. Detailed workup to check for evolving APS II is prudent in a hypothyroid patient presenting with pallor and jaundice. It may alert physicians to possible adrenal crisis in the future, especially after starting levothyroxine replacement in these patients.<\/jats:p>","DOI":"10.1136\/bcr-2018-228490","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T12:45:26Z","timestamp":1554727526000},"page":"e228490","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Jaundice and anaemia as presenting features of an incomplete autoimmune polyglandular syndrome type II"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6656-8569","authenticated-orcid":false,"given":"Mainak","family":"Banerjee","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit Kumar","family":"Mondal","sequence":"additional","affiliation":[{"name":"Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indira","family":"Maisnam","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, R.G. Kar Medical College and Hospital, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apurba Kumar","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"2025082800234410000_12.4.e228490.1","unstructured":"Neufeld M , Blizzard RM . et al Polyglandular autoimmune diseases. In: Pinchera A , Doniach D , Fenzi GF , Baschieri L , . eds. Symposium on Autoimmune Aspects of Endocrine Disorders. New York: Academic Press, 1980:357\u201365. et al ."},{"key":"2025082800234410000_12.4.e228490.2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-0044"},{"key":"2025082800234410000_12.4.e228490.3","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1035684"},{"key":"2025082800234410000_12.4.e228490.4","unstructured":"Neufeld M , MacLaren N , Blizzard R , et al . 154\u2013162. Pediatric Annals 1980."},{"key":"2025082800234410000_12.4.e228490.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2004.02561.x"},{"key":"2025082800234410000_12.4.e228490.6","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.bjhh.2015.07.008","article-title":"Spurious laboratory alterations in pernicious anemia","volume":"37","author":"Roque","year":"2015","journal-title":"Rev Bras Hematol Hemoter"},{"key":"2025082800234410000_12.4.e228490.7","doi-asserted-by":"crossref","first-page":"3545","DOI":"10.18203\/2320-6012.ijrms20173559","article-title":"A prospective study among cases of the pancytopenia on the basis of clinic-hematological analysis and bone marrow aspiration","volume":"5","author":"Mansuri","year":"2017","journal-title":"International Journal of Research in Medical Sciences"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:23:54Z","timestamp":1756365834000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,8]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bcr-2018-228490"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228490","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}