BACKGROUND: Overlap syndrome is a large group of condition that manifests with symptoms from two or more autoimmune conditions and satisfies the diagnostic criteria of at least two connective tissue diseases in the same patient. This condition might be unrecognized by the primary care physician and underreported.
CASE: A 30-year-old female had a 10-week history of non-pruritic erythematous macules on her face that gradually spread to her trunk, and upper extremities which progressed to hyperpigmented macules and tightening of the skin. There was note of hair loss, anemia, ulcerating wounds on distal extremities and finger tips. She then developed generalized body weakness and easy fatigability. Physical and laboratory examinations were consistent with SLE and scleroderma. 2D-echocardiogram showed a large pericardial effusion and pulmonary hypertension. She was treated with prednisone and azathioprine which in less than a week, diminished significantly the pericardial effusion. Patient also complained of a few day history of unilateral blurring of vision which turned out to be central retinal artery occlusion.
CONCLUSION: Overlap syndrome is a disease entity to consider in patients with multiple symptoms that cannot be classified into one connective tissue disease. Treatment of this disease should be individualized and based on the connective tissue diseases involved.

Human ; Female ; Adult ; Prednisone ; Azathioprine ; Pericardial Effusion ; Connective Tissue Diseases ; Torso ; Extremities ; Hypertension, Pulmonary ; Alopecia ; Anemia ; Retinal Artery Occlusion

Introduction: Type 2 diabetes mellitus (DM) is one of the leading non-communicable causes of death in the Philippines with a prevalence of 5.4% and its pathogenesis includes insulin resistance correlated with excess weight and BMI. Asian-based studies have shown that serum C-peptide is strongly associated with newly diagnosed diabetes and has a linear increasing trend with BMI, hence, this study aimed to determine the correlation of body mass index (BMI) with fasting C-peptide levels in Filipino patients with newly diagnosed type 2 DM. Also, to determine the correlation of fasting C-peptide, markers of insulin secretion and sensitivity (Homeostasis Model Assessment of beta cell function and insulin resistance: HOMA-IR, HOMA-B) with other metabolic parameters in newly diagnosed diabetics: waist circumference, HbA1C, fasting blood sugar (FBS), lipid profile. Methods: This cross-sectional study included 35 treatment naïve, newly diagnosed type 2 DM Filipino patients evaluated with anthropometric measurements, fasting C-peptide, and other metabolic parameters. The correlations among fasting C-peptide, BMI, waist circumference, FBS, HbA1c, lipid profile, HOMA-IR, and HOMA-B were determined using Pearson correlation. Results: A significant positive relationship were observed between BMI and HOMA-IR(r=0.335); C-peptide and waist circumference (r=0.363); C-peptide and HOMA-B(r=0.357); HOMA-IR and C-peptide (r=0.892); HOMA-IR and waist circumference (r=0.438); HOMA-IR and triglycerides (r=0.543). HOMA-B was negatively correlated with FBS and HbA1C (r=- 0.771, and r=-0.641, respectively). No correlation was seen between BMI and C-peptide (p=0.61). Conclusion Body mass index (BMI) is not correlated with fasting C-peptide levels in newly diagnosed type 2 DM Filipino patients. The positive relationship between C-peptide, waist circumference, and HOMA-IR merits further evaluation with larger studies.
C-Peptide ; Diabetes Mellitus, Type 2 ; Body Mass Index ; Insulin Resistance