Atypical case of primary sjögren’s syndrome with psychiatric disorder

Primary Sjögren's Syndrome (PSS) is a systemic autoimmune disorder characterized by chronic inflammation of exocrine glands. Neurological manifestations are sometimes found in patients with PSS, and both the Central Nervous System (CNS) and Peripheral Nervous System (PNS) can be involved. Psychiatric disorder is a rare manifestation caused by PSS. Herein, we report a 67-year-old woman admitted from the department of neurology for further investigations of progressive psychiatric abnormalities. High titers (1:320) of Antinuclear Antibodies (ANA) and antibodies against SSA and Rheumatoid Factor (RF) were detected. Rheumatology review revealed a history of Sicca symptoms and her Schirmer's test was positive. This lead to the diagnosis of CNS complications associated with PSS. She had an excellent response to intravenous methylprednisolone followed by oral prednisolone and intravenous immunoglobulin infusions. This case highlights that CNS involvement can precede the diagnosis of PSS. For a patient with psychiatric disorder, attention should be paid to screening for accompanying PSS, especially in female patients.