Background: Patients with autoimmune thyroid diseases (ATD) such as Graves’ disease (GD) and Hashimoto thyroiditis (HT) may have non-organ specific autoantibodies such as antinuclear antibodies (ANA) and rheumatoid factor (RF). Aim: To study the prevalence of rheumatic autoantibodies in a group of ATD patients without known rheumatic diseases and to evaluate its association with the patients’ epidemiological and treatment profiles. To follow positive non-organ specific autoantibody-positive ATD individuals to investigate whether they will develop a rheumatic disorder. Methods: A sample of 154 ATD patients (70 HT and 84 GD; mean age 45.3 ± 14.2) had determination of ANA by immunofluorescence, using hep-2 cells as substrate, extractable nuclear antigen profile by ELISA kits and RF by latex agglutination. Epidemiological and treatment profiles were obtained through chart review. These patients were followed for the mean period of 5 years, between 2010 and 2015. Results: Positive ANA was found in 17.5% (27/154) of the patients: anti-Ro/SS-A in 4/154 (2.5%); anti-RNP in 4/154 (2.5%), and anti-La/SS-B in 3/154 (1.9%). None had anti-Sm antibodies. RF was detected in 12/154 (7.7%) of ATD patients and was more common in older individuals (p = 0.007). There was a positive association between the presence of RF and ANA (p = 0.03; OR 3.89; 95% CI 1.1–13.3). None of the patients with positive autoantibodies developed clinical rheumatic diseases during the period of observation. Conclusion: We found rheumatic autoantibodies in 17.5% of ATD patients without rheumatic diseases. None of them were associated with the appearance of clinical rheumatic disorder during the period of 5 years.

INTRODUCTION: Children with comorbidities are at greater risk of developing severe forms of Covid-19. This paper reports a case of Mucopolysaccharidosis Type 2 (MPS-II) that presented complete recovery after severe Covid-19. CASE DESCRIPTION: Male, 13 years old, with MPS-II, is seen in a pediatric emergency room due to respiratory distress, airway hypersecretivity and fever. On physical examination, he had room air desaturation, snoring and diffuse coarse rales on pulmonary auscultation. Laboratory tests revealed: rod-like cell count, cytoplasmic vacuolization in neutrophils, thrombocytopenia, consumption coagulopathy, toxic level of valproic acid, respiratory acidosis and metabolic alkalosis; in addition to positivity for Covid-19. Chest radiography showed perihilar infiltrate with retrocardiac consolidation. Computed tomography of the chest showed bilateral perihilar and basal consolidations, in addition to bilateral endobronchial dissemination. Electrocardiogram showed changes in ventricular repolarization and ST-segment depression. Thus, Covid-19 infection was diagnosed, with secondary bacterial pneumonia and hemodynamic and cardiac repercussions, concomitant valproic acid intoxication. The patient required intensive care for 22 days, mechanical ventilation support for 19 days, in addition to the use of vasoactive drugs. He was discharged from hospital after 49 days, with gastrostomy, tracheostomy and home oxygen. COMMENTS: MPS-II carriers tend to have most severe form and worse prognosis when infected with Covid-19. This is because there are factors inherent to MPS-II that make it difficult to recover after pulmonary infections, such as: previous pulmonary dysfunction, macroglossia, adenoid hypertrophy, hypersecretivity and hypotonia. Such factors reflect the long hospital stay of patient reported when they get Covid-19.

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