MEDizzy - A 55-year-old woman presents with dry eyes, a dry mouth, and

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General Pathology (I)

A 55-year-old woman presents with dry eyes, a dry mouth, and difficulty swallowing solid food. Physical examination finds enlargement of her parotid glands along with marked dryness of her buccal mucosa. Laboratory examination finds the presence of both SS-A and SS-B antibodies. A biopsy of her lip is likely to show infiltration of minor salivary glands by what type of inflammatory cell?

ExplanationThe combination of dry eyes (keratoconjunctivitis) and dry mouth (xerostomia) in an adult woman is suggestive of Sjögren syndrome, an autoimmune disorder characterized by immunologic destruction of the lacrimal and salivary glands. This disorder is characterized by the presence of SS-A and SS-B autoantibodies, but the diagnosis of Sjögren syndrome is confirmed by finding a lymphocytic infiltrate within minor salivary glands from a biopsy of the lip. Lymphocytic infiltrates are characteristic of organs affected by autoimmune diseases. In addition to enlargement of the salivary glands, the lymph nodes of patients with Sjögren syndrome may be enlarged due to a pleomorphic infiltrate of B lymphocytes. Indeed patients have an approximately 40-fold increased risk for developing non-Hodgkin lymphoma, especially marginal zone lymphoma. The majority of individuals with Sjögren syndrome have manifestations of other autoimmune disorders, such as systemic lupus erythematosus (SLE), rheumatoid arthritis, or systemic sclerosis, and involvement of the lungs and kidneys does occur. Glomerular lesions are very rare, but a mild tubulointerstitial nephritis is quite common and may result in renal tubular acidosis.