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February 27, 1987

Primary Sjögren's Syndrome After Infectious Mononucleosis

Author Affiliations

Bascom Palmer Eye Institute University of Miami School of Medicine

Bascom Palmer Eye Institute University of Miami School of Medicine

JAMA. 1987;257(8):1049-1050. doi:10.1001/jama.1987.03390080039017

To the Editor.—  Primary Sjögren's syndrome is an immune disorder consisting of keratoconjunctivitis sicca and dry mucosal surfaces without an associated connective-tissue disorder.1 This disease has characteristic autoantibodies, HLA association, and glandular histopathology.2-4 We have examined two patients with primary Sjögren's syndrome occurring after infectious mononucleosis.

Report of Cases.—Case 1.—  A 5-year-old girl had parotid gland swelling, fever, and pharyngitis. Her white blood cell count was 9200/mm3 (9.2×109/L), with 7% (0.07) atypical lymphocytes. Epstein-Barr virus (EBV) titers one month after onset were as follows: viral capsit antigen (VCA) IgM, 1:40; VCA IgG, 1:320; and Epstein-Barr virus— associated nuclear antigen, 1:128. The serum IgG level was seven times normal and circulating immune complexes were present. Over the next two months, she was noted to have no tears when she cried. A Schirmer's test revealed 3 mm of wetting; 50% of the interpalpebral zone stained