Aseptic meningitis followed by mononeuritis multiplex in a patient with primary Sjögren's syndrome

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Primary Sjögren's syndrome is an autoimmune disorder primarily affecting exocrine glands.
• Neurological manifestations in Sjögren's syndrome can be diverse, including meningitis and peripheral neuropathy.
• Aseptic meningitis and mononeuritis multiplex are rare but serious complications.

Observation:

• A 38-year-old woman presented with fever, headache, and aseptic meningitis.
• She subsequently developed left forearm pain, sensory disturbance, and drop fingers due to mononeuritis multiplex.
• Electrophysiological studies confirmed sensorimotor neuropathy in the left radial nerve.

Findings:

• The patient was diagnosed with primary Sjögren's syndrome, positive for anti-Ro/SS-A antibodies.
• Treatment involved methylprednisolone, intravenous immunoglobulin, and cyclophosphamide, followed by oral glucocorticoids.
• Neurological symptoms, particularly drop fingers, showed significant improvement after intensive immunotherapy.

Implications:

• This case highlights the importance of recognizing and managing neurological complications in primary Sjögren's syndrome.
• Intensive immunotherapy can be effective in treating aseptic meningitis and mononeuritis multiplex associated with Sjögren's syndrome.
• Early diagnosis and aggressive treatment are crucial for improving outcomes in patients with Sjögren's-related neurological disorders.