ACUTE BILATERAL INFLAMMATORY DACRYOADENITIS AS A PRESENTING SIGN OF SJÖGREN’S SYNDROME.

Acute dacryoadenitis is an atypical manifestation of Sjögren’s syndrome. Sjögren’s syndrome is an autoimmune disorder causing chronic lacrimal and salivary gland destruction, which results in severe dry eyes and mouth. We present an uncommon case of Sjögren’s syndrome presenting as acute bilateral dacryoadenitis. The aims of this poster are to present the clinical findings of an uncommon case of Sjögren’s syndrome, including initial work-up, investigation results and final diagnosis. This poster further aims to increase clinician awareness on the variety of manifestations of acute inflammatory ocular disease.

The setting was in Bedford Hospital NHS Trust. The patient was initially clerked within the Emergency Department, and subsequently managed by the acute medicine, ophthalmology and rheumatology teams.

Verbal and signed consent were obtained directly from the patient in accordance with BMJ policy. Anonymised medical clerking notes, discharge letters, investigation and imaging results were then reviewed retrospectively using electronic patient medical records.

A 20 year old female patient presented to the Emergency Department with headache, progressive bilateral eye pain and swelling. CT imaging of the orbits showed acute bilateral inflammatory dacryoadenitis and there was evidence of chronic lymphocytic infiltration on a subsequent lacrimal gland biopsy. Inflammatory blood panels showed a positive ANA with a speckled pattern, further raising clinical suspicion of an autoimmune etiology such as Sjogren's syndrome or Systemic Lupus Erythematosus. Due to the patient's prior history of dry eyes and the investigation findings, she was diagnosed with Sjögren’s syndrome by the rheumatology team.

This was an atypical presentation of Sjögren’s syndrome, managed in a multi-disciplinary manner between the emergency department, acute medicine, ophthalmology and rheumatology teams. A short interview was conducted with the patient who is currently being maintained on hydroxychloroquine therapy and has had no further episodes of inflammatory dacryoadenitis.