Year Disease Findings Rx (current) Childhood Mucocutaneous candidiasis     1970 Dental abnormalities Unknown   1970 Hypoparathyroidism Tetany Currently serum calcium ranges 6.5 – 8.2 mg/dl (Nl 8.5 – 10.5 mg/dl) Calcitriol 0.5 mcg (9x a week). Calcium carbonate 500 mg QID with meals 1984 Keratoconjunctivitis Anti-nuclear antibody (ANA) + Non-prescription eye drops 1992 Dysphagia Esophageal stricture Candidiasis Barium swallow demonstrated “Esophageal contour abnormality at the level of the thoracic inlet which is stable in appearance since 1992.” Dilatation Nystatin 1994 Hypothyroidism Thyroid peroxidase (TPO) + TPO 212.7 IUL/ml in 2005 (Positive >2.0 IUL/ml) Levothyroxine 1997 Menopause Age 42   1998 Pernicious anemia B12 deficiency B12 <100 pcg/ml (Nl >250 pcg/ml) Cyanocobalamin 1000 pcg by injection every 2 weeks 2000 Type I diabetes Glucose 518 (Nl 70-110 mg/dl) Insulin 2002 Sicca symptoms ANA +, Ro+, Raynaud’s Punctual plugs 2002 Retinopathy Not considered typical of diabetic retinopathy by ophthalmology None 2002 Dyslipidemia Cholesterol 275 mg/dl (Nl <200) Atorvastatin 40 mg QHS 2004 Alopecia totalis     2005 Bone Mineral Density (BMD) BMD Lumbar Spine: 1.28 gms/cm2 T score 2.20, Z score 2.80 BMD Femoral neck: 1.16 gms/cm2 T score 2.80, Z score 3.50   2005 Autoimmune hepatitis Anti-smooth muscle antibody negative, and antimitochondrial antibody negative. Biopsy: Chronic hepatitis with bridging fibrosis Azathioprine 50 mg QD 2007 Sjogren’s ANA 1:5120 homogenous, Ro+ and anti-mitotic spindle apparatus antibodies positive 1:5120 Hydroxychloroquine 200 mg BID 2007 Iron deficiency Fe 18 ug/dl (Nl 30-160) TIBC 438 (Nl 275-425) Ferritin 5 ng/ml (Nl 11-307) Intra-muscular iron , then ferrous gluconate 325 mg TID 2007 Esophageal stricture, choking episodes Persistent thoracic inlet level stricture and monilial esophagitis Dilatation, omeprazole and fluconazole 2008 Perioral dermatitis Working diagnosis rosacea Erythromycin

Table 1: Sequence of disease manifestations.