An unusual cause for sicca syndrome.

Area of Science:

• Rheumatology
• Hematology
• Oncology

Background:

• Sjögren's syndrome (SS) is an autoimmune disorder primarily affecting exocrine glands.
• Patients with SS often exhibit circulating monoclonal immunoglobulins.
• Smouldering myeloma (MM) is an asymptomatic plasma cell disorder.

Observation:

• A 47-year-old female presented with three months of sicca symptoms, diagnosed as primary SS.
• Serum electrophoresis revealed an M band and elevated gamma globulin (46 g/L).
• Bone marrow aspiration showed 28% plasma cells, leading to an MM diagnosis due to absence of organ damage.

Findings:

• The patient received treatment with thalidomide and dexamethasone for MM.
• Sicca symptoms resolved following the anti-myeloma therapy.
• This case suggests MM can rarely present as SS, with symptoms improving upon MM treatment.

Implications:

• Highlights the importance of serum electrophoresis in diagnosing SS to detect underlying MM.
• Demonstrates that sicca symptoms can be an initial manifestation of MM.
• Underscores the need for a thorough hematological workup in SS patients, especially with rapid symptom onset or specific M band findings.