Korean J Med.  2009 Aug;77(2):261-264.

A case of rheumatoid arthritis with Sjogren's syndrome presenting as a tonic pupil

• Koh JK
• Kim J
• Ryu HJ
• Lee EY
• Lee YJ
• Lee EB
• Song YW

Abstract

Sjogren's syndrome is an autoimmune disease that presents mainly as dry eyes and mouth, and occasionally with extra-glandular symptoms. A peripheral neuropathy is present in 10~30% of the cases with extra-glandular symptoms, although a tonic pupil caused by destruction of the ciliary ganglion is rare. We report a case of rheumatoid arthritis with Sjogren's syndrome presenting as a tonic pupil. A 29-year-old woman was admitted for evaluation of polyarthralgia and a tonic pupil. On physical examination, she had polyarthritis involving the jaws, shoulders, wrists, and hands. Her pupils were anisocoric and did not react to light, but constricted promptly to pilocarpine. Biopsy of the minor salivary gland showed lymphocyte infiltration. Rose-Bengal stain was positive. She was diagnosed with rheumatoid arthritis with Sjogren's syndrome and treated with prednisolone and hydroxychloroquine. Three months later, her polyarthritis had improved markedly, but she still had a tonic pupil.

Keyword

Sjogren's syndrome; Rheumatoid arthritis; Tonic pupil

MeSH Terms

Adult
Arthralgia
Arthritis
Arthritis, Rheumatoid
Autoimmune Diseases
Biopsy
Eye
Female
Ganglion Cysts
Hand
Humans
Hydroxychloroquine
Jaw
Light
Lymphocytes
Mouth
Peripheral Nervous System Diseases
Physical Examination
Pilocarpine
Prednisolone
Pupil
Salivary Glands, Minor
Shoulder
Sjogren's Syndrome
Tonic Pupil
Wrist
Hydroxychloroquine
Pilocarpine
Prednisolone