Metwalley and Farghaly Journal of Medical Case Reports 2012, 6:221 http://www.jmedicalcasereports.com/content/6/1/221 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Hepatitis C virus infection in a child with autoimmune polyendocrine syndrome type 2: a case report Kotb Abbass Metwalley* and Hekma Saad Farghaly Abstract Introduction: Autoimmune polyendocrine syndrome type 2 is a rare disorder. Its prevalence in western populations has been reported as 1.5 to 4.5/100,000. On the other hand, its prevalence in Egypt is unknown. It is characterized by the association of autoimmune Addison’s disease with thyroid autoimmune diseases and/or type I diabetes mellitus. Hepatitis C virus infection is an important public health issue worldwide. Egypt has the highest prevalence of hepatitis C virus infection of any country in the world. It is estimated to be 8% in urban and 25% in rural areas. We present the case of an Egyptian child with autoimmune polyendocrine syndrome type 2 associated with chronic hepatitis C infection. Case presentation: A 14-year-old Egyptian boy with type 1 diabetes mellitus was referred to our institution for an evaluation of recurrent attacks of hypoglycemia of two months duration. The initial clinical examination revealed hypotension as well as vitiligo of the skin. He had high potassium, low sodium, low cortisol, high adrenocorticotropic hormone, slightly high thyroid stimulating levels with strong positivity of anti-thyroglobulin and anti-thyroid peroxidase antibodies. The hepatitis C antibody and hepatitis C virus–polymerase chain reaction were positive. Based on these findings, a diagnosis of autoimmune polyendocrine syndrome type 2 with chronic hepatitis C was made. He was started on hydrocortisone (10mg twice daily), fludrocortisone (0.1mg twice daily) and multiple daily doses of insulin. He showed great improvement of his symptoms on the prescribed treatment. Conclusions: The importance of the early diagnosis of autoimmune polyendocrine syndrome type 2 and the possibility of its association with chronic hepatitis C infection should be considered in order to implement the proper management of such cases. Introduction Autoimmune polyendocrine syndrome (APS) is a rare syndrome caused by immune-mediated destruction and involves the failure of both endocrine and non-endocrine organs. It is characterized by an insufficiency in at least two endocrine glands. Four main types of APS have been described [1]. Autoimmune polyendocrine syndrome type 2 (APS2) (Schmidt's syndrome) is defined by the co- existence of autoimmune Addison’s disease with auto- immune thyroid disease and/or type 1 diabetes mellitus (T1DM). Some of the patients may later develop other autoimmune diseases, such as vitiligo, alopecia, chronic atrophic gastritis, pernicious anemia, chronic hepatitis * Correspondence: kotb72@yahoo.com Pediatric Endocrinology & Diabetes Unit -Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt and celiac disease [2]. The prevalence of antibodies to hepatitis C virus (anti-HCV) among Egyptian children ranges between 3% to 9% [3]. To the best of our know- ledge, the association between chronic hepatitis C and APS2 has not been reported before in the literature. We present the case of an Egyptian child who presented with APS2 associated chronic hepatitis C. Case presentation A 14-year-old Egyptian boy was referred to our institu- tion for evaluation of recurrent hypoglycemic attacks which occurred especially in the mornings during the preceding two months. He had been diagnosed with T1DM at the age of five years and was treated with insu- lin in a dose of 0.7 to 1U/kg since that time. Recently, he started to develop recurrent attacks of hypoglycemia © 2012 Metwalley and Farghaly; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.