Atypical Presentation of Sjogren's Syndrome With Chronic Urticaria: A Case Report and Literature Review

We present a case of a 26-year-old female with a history of 6-8 months of recurrent severe allergic reactions with anaphylaxis who presented with bilateral shoulder arthralgia and inflammatory arthritis of the right hand involving metacarpophalangeal joints (MCP). Physical examination was significant for tenderness in shoulder and knee joints, swelling, warmth, and tenderness involving MCP joints of the right hand. Schirmer's test was positive in both eyes. Further workup revealed positive antinuclear antibody (ANA) (speckled pattern), anti-Ro antibodies, and elevated inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient was diagnosed with Sjogren's syndrome and was started on methotrexate once weekly and hydroxychloroquine with significant improvement in the symptoms. Also, we review the literature describing the association between chronic urticaria and rheumatological diseases. This case highlights the varied presentation of rheumatological diseases.