A case of rheumatoid arthritis with Sjögren’s syndrome presenting as a tonic pupil

Jae Ki Koh,; Jinhyun Kim,; Hee Jeong Ryu,; Eun Young Lee,; Yoon Jong Lee,; Eun Bong Lee,; Yeong Wook Song,

Korean J Med > Volume 77(2); 2009 > Article

Original Article

The Korean Journal of Medicine 2009;77(2):261-264.

A case of rheumatoid arthritis with Sjögren’s syndrome presenting as a tonic pupil

Jae Ki Koh, Jinhyun Kim, Hee Jeong Ryu, Eun Young Lee, Yoon Jong Lee, Eun Bong Lee, Yeong Wook Song

긴장성 동공으로 발현한 류마티스 관절염과 동반된 쇼그렌 증후군 1예

고재기, 김진현, 류희정, 이은영, 이윤종, 이은봉, 송영욱

Abstract

Sjögren’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 Sjögren’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 Sjögren’s syndrome and treated with prednisolone and hydroxychloroquine. Three months later, her polyarthritis had improved markedly, but she still had a tonic pupil. (Korean J Med 77:261-264 2009)

Key Words: Sjögren’s syndrome; Rheumatoid arthritis; Tonic pupil