046 Construction of a detailed historical longitudinal personal medical journey identifies critical non-genetic determinants of disease in a patient with pemphigus vulgaris

While predisposing genetic factors have been implicated across a variety of autoimmune diseases, the inherited risk they carry has failed to completely account for development disease in any given individual. In fact, etiology autoimmunity is complex and multifactorial, involving both non-genetic factors. The lack full concordance as revealed by monozygotic twins studies conditions support importance social determinants health (SDH) initiation clinical course disease. Pemphigus vulgaris (PV) long studied prototypical, humorally mediated, organ-specific, Presented here are findings from complete life history taken 54 year old White female who living embodiment interplay between susceptibility (HLA DRB1*0402+) cast psychological (adverse childhood events, psychosocial stress), physical (sustained exposure agricultural darkroom/photographic developing chemicals), (Hashimoto's thyroiditis), dietary that demonstrate not only unique constellation these well documented single patient went on develop PV, power altering selected environmental factors, namely diet this case, ameliorating severity significantly improving quality life. Our data highlight essential role key longitudinal taking monitoring uncover relevant activity individuals. use such collection methods obtain real world further push towards personalized medicine revealing risks underpinning and, perhaps most importantly, provide potential avenues prevention where SDH implicated.