Subacute Onset Sensorimotor Axonal Neuropathy with Sicca Syndrome.

ABSTRACT

We present the case of a 65-year-old female, with no prior medical history, who came to our attention for painful paresthesias involving the distal lower limbs and progressive gait disturbance, accompanied by fatigue, involuntary weight loss, xerophthalmia and xerostomia. Due to a right-sided cervical tumefaction, cervical MRI was performed and revealed an enlarged right parotid gland. Electroneurography confirmed the presence of a chronic sensorimotor axonal neuropathy with active denervation. Blood and urinary samples were collected, highlighting the presence of anti SS-A and SS-B antibodies, with cryoglobulinemia, IgM monoclonal band and kappa light chain monoclonal band. No malignancies were found after extensive workup and bone marrow aspiration was normal. Consequently, a diagnosis of Sjögren syndrome-associated peripheral neuropathy with cryoglobulinemia was established, and after plasma exchange, partial improvement of the patient's gait was noted.