A multidisciplinary approach to management of autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED)

BMJ Case Rep. 2013 Jan 30:2013:bcr2012008116. doi: 10.1136/bcr-2012-008116.

Abstract

We present a case of an 18-year-old Caucasian man with a rare autosomal recessive disorder called autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED). This patient had manifestations of all clinical components of this multisystemic disease which included intestinal failure secondary to autoimmune enteropathy. We present a unique multidisciplinary management for this genetic condition. Although patients with APECED do not always have all the disease components (a total of eight exist), the majority have at least 3-5 components. This excludes the psychosexual implications which are often ignored. This case highlights the importance of (1) management of APECED in a multidisciplinary nature that includes a gastroenterologist, immunologist, endocrinologist, dietitians, etc and the (2) management of intestinal failure component of APECED is best suited in a specialist intestinal failure unit where expertise is available for complex malabsorption disorders.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Candidiasis, Chronic Mucocutaneous / etiology
  • Candidiasis, Oral / etiology
  • Colonoscopy
  • Duodenal Diseases / etiology
  • Duodenal Diseases / pathology
  • Duodenum / pathology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Malnutrition / etiology
  • Nutrition Therapy
  • Patient Care Team
  • Polyendocrinopathies, Autoimmune / complications
  • Polyendocrinopathies, Autoimmune / diagnosis
  • Polyendocrinopathies, Autoimmune / therapy*
  • Rituximab

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Immunosuppressive Agents
  • Rituximab