From sine syndrome to sjögren's syndrome

Abstract

Reports on sine syndromes - diseases that have defined clinical syndromes, such as systemic lupus erythematosus, scleroderma, and dermatomyositis with the absence of autoantibodies or, on the contrary, typical immunological features and laboratory tests without clinical symptomatology corresponding to a concrete nosologic entity - have recently appeared in scientific literature on rheumatology. We present the case of an 11-year-old female patient with a history of Epstein-Barr virus infection with parotitis and lymphadenitis, and who had high humoral activity and high titers of autoantibodies (ANA, ENA, anti-SS-A, and anti-SS-B) during the preliminary examination, without the clinical manifestations that would correspond to lupus erythematosus or Sjögren's syndrome. On admission to the clinic, only lymphadenopathy and mild tumescence of the parotid gland were present. Fatigue, arthralgia, myalgia, gastrointestinal, and ophthalmic signs were repeatedly not found. After 21 months of follow-up, we confirmed a positive Schirmer's test, and a subsequent biopsy of the small salivary glands allowed us to diagnose Sjögren's syndrome.