Abstract
Here we report a case of Sjögren's syndrome (SjS) preceding systemic lupus erythematosus (SLE). A 37-year-old woman was admitted to our hospital in October 1993 because of xerophthalmia, xerostomia, fever and facial erythema.
She had been pointed out hypergammaglobulinemia and leukopenia since 1973 (17-year-old) in the absence of clinical manifestations. She noticed easy fatigability and hypersen-sitivity to common cold in 1985, and then lymph node swellings in both neck and axilla were recognized. Diagnosis of primary SjS was based clinically on Raynaud's phenomenon, dry eyes and dry mouth, and serologically on positive autoantibodies to nuclear antigen, SS-A (Ro) and SS-B (La) antigens. The presence of anti-dsDNA antibody was occurred in August 1992. Five months later, she had suffered from high fever, joint pain, facial erythema. Laboratory data showed albuminuria and high titer of anti-Sm antibody.
On admission, Shirmer's, rose-bengal and gum tests were also positive. The load test of NH4Cl was also positive. Mouth lip biopsy exhibiting mononuclear cell infiltration around ducts diagnosed SjS. Furthermore, renal biopsy showed focal segmental glomerulonephritis. Immunoglobulins and complements were deposited on the mesangeal cells in glomeruli. Mononuclear cell infiltration and fibrosis was found moderately in interstitium. The data depicted category IIIa in WHO morphological classification of lupus nephritis.
In our present case, SjS precedes SLE by 4 years, and both diseases occurs after a long latent period. This case is very interest in pathogenesis in both diseases and the relationship between them.
