Calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia (CREST) syndrome, a limited form
of systemic sclerosis, is sometimes complicated by primary biliary cirrhosis (PBC). A 52- and 61-year-old Japanese woman with
PBC–CREST overlap syndrome accompanied by Sjögren's syndrome, and Hashimoto’s thyroiditis, and Graves’ disease, respectively,
are reported. They had suffered from Raynaud’s phenomena, sclerodactyly, morning stiffness, arthralgia, and sicca symptoms
during these several years. They exhibited an increased level of alkaline phosphatase, γ-glutamyl transpeptidase, positive
antibodies against mitochondria and centromere, and hyperglobulinemia without any cholestatic symptoms. Histological findings
from liver biopsy specimens were consistent with those of PBC. Clinically, they were diagnosed as both asymptomatic PBC and
incomplete CREST syndrome. Their human leukocyte antigen typing showed both DR4 and DR8 positive. The association of the four
autoimmune conditions is clinically and etiologically important. Although a combination of these diseases is rare, it is of
importance to keep in mind that various autoimmune diseases could occur simultaneously. Of critical importance is that an
active diagnostic attitude towards them is admirable, and that early diagnosis and therapy are needed.
Keywords CREST syndrome - PBC - Sjögren's syndrome - Thyroid dysfunction