Primary Sjogren's syndrome presenting as ptosis and eyelid swelling: A case report.

Key Clinical Message: This unique case report of primary Sjogren's syndrome (pSS) shows bilateral ptosis and significant periorbital edema, compromising vision. To avoid misleading diagnosis, antibody tests must be evaluated and interpreted in the context of clinical findings. Abstract: Primary Sjögren's syndrome is an idiopathic, autoimmune disorder involving the lacrimal and salivary glands characterized by both localized and systemic manifestations including xerostomia and keratoconjunctivitis sicca. Myasthenia Gravis (MG) is also an autoimmune disorder characterized by the development of auto-antibodies against nicotinic acetylcholine receptors that causes decreased muscle response to stimulation. It usually presents with ptosis and generalized body weakness. Ophthalmological involvement is common in both disorders but ptosis is very rarely seen in pSS. We report the case of a 27-year-old woman presenting to our clinic with the complaint of ptosis and eyelid swelling. She also had a positive anti-acetylcholine receptor antibody test and her initial presentation mimicked Myasthenia Gravis. Her autoimmune workup revealed a positive titer of Anti Ro SSA antibodies. Myasthenia Gravis was ruled out on electrodiagnostic studies which showed no decremental response, and pSS was confirmed on lip biopsy. Our case highlights that it is important to interpret the antibody test results in the context of clinical findings as we can have spurious results in autoimmune diseases. Autoimmune conditions can have varying presenting complaints hence, clinical judgment should always overrule diagnostic investigations and should thus guide patient management.

Dengue hemorrhagic fever: comparison of patients with primary and secondary infections.

BACKGROUND: Dengue hemorrhagic fever (DHF) is considered to be associated with secondary dengue infection. This study was conducted to note frequency of primary and secondary dengue infection in DHF patients. Additionally these patients were compared in terms of age, gender, laboratory parameter, diseases severity and outcome. MATERIALS AND METHODS: In this cross sectional observational study DHF patients fulfilling DHF criteria of Dengue Expert Advisory Group (DEAG) were included and divided into groups based on dengue specific IgG positivity and ratio of IgM to IgG. Group I, patients with secondary dengue infection were IgG positive or their ratio of IgM to IgG was <1.2. Group II, primary dengue infection patients were IgG negative or their ratio of IgM to IgG was >1.2. The two Groups were compared for statistically significant association in terms of age, gender, laboratory parameter (at admission hematocrit [HCT], platelet, white blood cell [WBC] counts, alanine aminotransferase [ALT] value), severity (DHF or dengue shock syndrome), and outcome (recovered or expired). RESULTS: Two hundred thirty-four DHF patients were included. 66.2% was male and 33.8% female. Mean patient age was 28.8 ± 12.4 years. Based on dengue markers results, 61.5% patients were categorized to Group I, and 38.5% to Group II. Statistically significant association between the two Groups was noted in terms of at admission platelet count, and ALT value, P value <0.05. CONCLUSION: Primary dengue infection is frequently associated with DHF. Patients with DHF caused by secondary dengue infection have lower at admission platelet counts and higher ALT value.