Gastric involvement in Sjögren's syndrome simulating early gastric carcinoma

The case of a 42-year-old woman with Sjögren's syndrome accompanied by severe gastric infiltration and interstitial nephritis is reported. Presentation was with finger stiffness, Raynaud's phenomenon and abdominal discomfort. There were endoscopic and radiological features of early cancer, type IIc (depressed type). Resected stomach showed atrophic gastritis with erosion. Histology showed focal to relatively diffuse destruction of the gastric glands with minimal intestinal metaplasia and dense collections of lymphoid cells with occasional germinal centers in the interstitium of the gastric mucosa. Renal biopsy revealed similar severe diffuse interstitial infiltration of lymphoid cells. Distal renal tubular acidosis was confirmed by sodium bicarbonate and ammonium chloride loading test. Satisfactory improvement in xerostomia, keratoconjunctivitis sicca and other laboratory data occurred on prolonged administration of adrenal steroids and cyclophosphamide.