LETTERS
Sjogren’s Syndrome and
64 patients in our series. W e appreciate D r Poser’s comment on the neurological complications of Sjogren’s syndrome. It was not our intention to review this topic but to examine a possible association between multiple sclerosis and primary Sjogren’s syndrome.
Multiple Sclerosis Charles M. Poser, M D The publication in the May 1990 issue of the Annals of Neurology of an article, an editorial, and a letter regarding the possible relationship between Sjogren’s syndrome and multiple sclerosis is of particular interest because they recall an episode that took place more than 30 years ago. A 50-yearold woman was admitted to the hospital with a history as well as clinical signs and symptoms highly suggestive of multiple sclerosis. In addition, however, she had complaints that were clearly unusual for such a diagnosis, such as many episodes of painful swelling of the parotid glands, burning and stinging of the eyes, and a gradual decrease in salivary secretion and total lack of tears. The patient’s original diagnosis on admission to the medical service was that of multiple sclerosis, which was “confirmed” by the presence in the cerebrospinal fluid of a highly positive colloidal gold curve on 3 different occasions with at least 3 different ratings of 5. Because of the tentative diagnosis of multiple sclerosis, which was questioned by D r Atwood (then a medical student), the patient was transferred to the neurology service where the correct diagnosis of Sjogren’s disease with neurological complications was established. This diagnosis was based on the fact that the patient’s serum proteins on two occasions were: albumin 2.96 and 2.54 gm% (normal, 3.4-5.0 gm%) and globulin 6.92 and 7.34 gm% (normal, 2.3-3.5 g m x ) ; these levels represent a highly significant inversion of the normal serum albumidglobulin ratio. Serum protein electrophoresis revealed a serum gammaglobulin of 539% of total protein (normal,
Sjogren’s Syndrome and
64 patients in our series. W e appreciate D r Poser’s comment on the neurological complications of Sjogren’s syndrome. It was not our intention to review this topic but to examine a possible association between multiple sclerosis and primary Sjogren’s syndrome.
Multiple Sclerosis Charles M. Poser, M D The publication in the May 1990 issue of the Annals of Neurology of an article, an editorial, and a letter regarding the possible relationship between Sjogren’s syndrome and multiple sclerosis is of particular interest because they recall an episode that took place more than 30 years ago. A 50-yearold woman was admitted to the hospital with a history as well as clinical signs and symptoms highly suggestive of multiple sclerosis. In addition, however, she had complaints that were clearly unusual for such a diagnosis, such as many episodes of painful swelling of the parotid glands, burning and stinging of the eyes, and a gradual decrease in salivary secretion and total lack of tears. The patient’s original diagnosis on admission to the medical service was that of multiple sclerosis, which was “confirmed” by the presence in the cerebrospinal fluid of a highly positive colloidal gold curve on 3 different occasions with at least 3 different ratings of 5. Because of the tentative diagnosis of multiple sclerosis, which was questioned by D r Atwood (then a medical student), the patient was transferred to the neurology service where the correct diagnosis of Sjogren’s disease with neurological complications was established. This diagnosis was based on the fact that the patient’s serum proteins on two occasions were: albumin 2.96 and 2.54 gm% (normal, 3.4-5.0 gm%) and globulin 6.92 and 7.34 gm% (normal, 2.3-3.5 g m x ) ; these levels represent a highly significant inversion of the normal serum albumidglobulin ratio. Serum protein electrophoresis revealed a serum gammaglobulin of 539% of total protein (normal,
