Pathology · patient case with 2 questions
Case: decreased saliva and decreased tears
Scenario: A patient presents with reduced salivary flow and reduced tear secretion.
Question 1
What is the diagnosis?
Show answer and explanation
Correct answer: B. Sjögren syndrome
- A. Lupus is characterised by a malar butterfly rash, photosensitivity, arthritis and renal involvement; sicca symptoms occur only when Sjögren coexists.
- B. Correct. The combination of xerostomia and keratoconjunctivitis sicca is the defining sicca complex of Sjögren syndrome, an autoimmune exocrinopathy with anti-SSA (Ro) and anti-SSB (La) antibodies.
- C. Rheumatoid arthritis alone affects joints. When it accompanies sicca symptoms, the diagnosis is secondary Sjögren syndrome.
- D. Sarcoidosis can enlarge the salivary glands (Heerfordt syndrome) but is a granulomatous disease with hilar lymphadenopathy, not a primary sicca syndrome.
Question 2
What other characteristic finding would you expect in this patient?
Show answer and explanation
Correct answer: D. Dry eyes (keratoconjunctivitis sicca)
- A. Salivary flow is reduced around the clock, which is why these patients have a high caries rate and candidal infection.
- B. Facial nerve palsy is not a feature. Parotid enlargement may occur, but the nerve is not paralysed.
- C. Tear production falls, not rises; that is the whole basis of the sicca complex.
- D. Correct. Lymphocytic destruction of the lacrimal glands produces gritty, burning dry eyes — assessed with the Schirmer test and rose bengal staining.
Note: Watch for the raised lymphoma risk in long-standing Sjögren — a persistently enlarged, firm parotid warrants biopsy.