A Confluence of Autoimmunity in a Male Patient: Severe Hypothyroidism with Massive Pericardial Effusion, Sjögren’s Syndrome, and Vasculitis

Abstract

We report a rare case of polyautoimmunity in a 40-year-old male presenting with massive pericardial effusion, severe primary hypothyroidism, primary Sjögren’s syndrome (SS), and leukocytoclastic vasculitis. While hypothyroidism and SS are predominantly female disorders, their confluence in a male patient presents unique
diagnostic challenges. The patient exhibited progressive dyspnoea, generalized weakness, xerosis, and purpuric rashes. Diagnostic workup revealed massive pericardial effusion requiring pericardiocentesis, TSH >100 mIU/L, and positive antiSSA/Ro and anti-SSB/La antibodies. He was treated with levothyroxine, corticosteroids, and supportive care, resulting in the resolution of the effusion, vasculitic lesions, and renal impairment. This case highlights the importance of screening for multiple autoimmune pathologies in patients presenting with complex, multisystemic illness to ensure timely and appropriate multidisciplinary management.