J Neurocrit Care.  2019 Jun;12(1):46-50. 10.18700/jnc.190077.

Recurrent aseptic meningitis as an initial clinical presentation of primary Sjögren's syndrome

• Lee DH
• Lee SJ

• KMID: 2452826
• DOI: http://doi.org/10.18700/jnc.190077

Abstract

BACKGROUND
The neurological manifestations of Sjögren's syndrome (SjS) are nonspecific and may precede the onset of sicca symptoms. Hence, the diagnosis of SjS is often delayed. Recurrent aseptic meningitis is an uncommon neurological manifestation of primary SjS; only few cases have been reported in the medical literature.
CASE REPORT
A 54-year-old woman was admitted for recurrent aseptic meningitis. The patient had a history of two episodes of aseptic meningitis, which had occurred 12 and 7 years before this presentation. The patient had overt sicca symptoms for 5 years. SjS was diagnosed based on the results of serum autoantibody tests, Schirmer's test, and salivary scintigraphy. We concluded that recurrent aseptic meningitis occurred as an initial presentation of primary SjS.
CONCLUSION
This case suggest that SjS should be included in the differential diagnosis of recurrent aseptic meningitis.

Keyword

Sjogren's syndrome; Meningitis, aseptic; Autoimmune diseases

MeSH Terms

Autoimmune Diseases
Diagnosis
Diagnosis, Differential
Female
Humans
Meningitis, Aseptic*
Middle Aged
Neurologic Manifestations
Radionuclide Imaging
Sjogren's Syndrome

Figure

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  Fig. 1. Brain magnetic resonance images with gadolinium enhancement. (A) Axial T2-weighted images show no abnormal signal intensity in the brain. (B) Axial T1-weighted images after administration of gadolinium show no abnormal parenchymal and meningeal enhancement.

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  Fig. 2. Scintigraphy of the salivary glands. Salivary gland scintigraphy revealed a remarkably low accumulation level and a poor response to secretion stimulation. ANT, anterior; RT, right; LAT, lateral; LT, left; WASH, washout.

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