Autoimmune disease patients should adhere to prescribed treatment regimens.

The immune system is responsible for recognizing and destroying invading bacteria and viruses, but in some cases it loses control and begins attacking healthy cells, leading to autoimmune disease.

A 27-year-old woman was diagnosed with lupus erythematosus with interstitial lung involvement in 2024 and had been treated stably. During pregnancy, she stopped her medication on her own and did not attend regular checkups, which was followed by miscarriage in the fifth month. After the loss, her condition worsened more severely, and she developed scleroderma and dermatomyositis—two additional autoimmune diseases—resulting in skin damage and severe muscle weakness.

Multi-organ flare during pregnancy and after treatment interruption

Dr. Bui Thi Thanh Tuyền, MD, PhD, Department of Clinical Immunology, Tam Anh General Hospital in Ho Chi Minh City, said that when the patient was admitted, the disease was attacking multiple organs at once, including the lungs and blood vessels, as well as the skin and the musculoskeletal system.

“The body can have multiple autoimmune antibodies simultaneously. When the immune system loses control, these antibodies fail to recognize healthy tissue and attack multiple organs,” the doctor explained.

According to Dr. Tuyền, pregnancy can change hormones and immune function, which may disturb immune balance in people whose condition is already unstable. The patient’s voluntary cessation of treatment during pregnancy further increased the risk of flare and the emergence of additional autoimmune diseases, contributing to physical and mental exhaustion and making treatment more complex.

Multiple Autoimmune Syndrome and overlap of four diseases

Autoimmune diseases are common in young women, particularly those aged 20–40, due to hormonal and immune factors. Dr. Tuyền noted that patients with three or more autoimmune diseases are classified as having Multiple Autoimmune Syndrome (MAS), a rare condition with a complex course.

“This is the first case at the hospital documenting overlap of four autoimmune diseases with clear multi-organ involvement, rapid progression, and high risk of complications,” the doctor said.

Treatment approach and patient response

The medical team emphasized that treatment must both control the disease and select appropriate intervention strategies because the patient’s body was weakened. If disease control is insufficient, the condition may continue to progress; however, overly aggressive intervention from the outset can increase the risk of complications.

Initially, doctors used immunosuppressive drugs according to standard protocols. However, the patient responded poorly, and the treatment was switched to biologic drugs designed to directly target the pathogenesis of the immune system.

After about a month, the patient gradually improved: she regained muscle strength and could stand and walk. She still requires long-term monitoring and treatment.

Implications for pregnancy in patients with autoimmune disease

In this case, doctors stated that women with autoimmune diseases can still become pregnant, but they require careful evaluation and close monitoring before, during pregnancy, and after birth. Patients are also expected to adhere to their prescribed treatment regimens. In many cases, clinicians can adjust treatment plans to control the disease while supporting pregnancy safety.