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Primary Sjögren's syndrome associated with recurrent sinopulmonary infections and bronchiectasis.

Sjigren's syndrome (SS) is an autoimmune disorder with unique involvement of the eyes and respiratory tract. Patients with SS frequently come to the allergist for evaluation.' We present the case of patient referred for evaluation of recurrent respiratory infections to rule out a diagnosis of immune deficiency. CASE REPORT A 58-year-old woman was evaluated for a history of recurrent sinopulmonary infections. Medical history revealed chronic rhinitis that was not associated with seasonal exacerbations. She had received antibiotics on many occasions for treatment of clinical sinusitis. She had four episodes of pneumonia associated with fever, productive cough, and an abnormal chest roentgenogram. She had noted the gradual onset of dry eyes and dry mouth. She noted intermittent episodes of painless swelling of the parotid glands. The sicca symptoms were not associated with medication use. Her pulmonary infections were easily treated with standard antibiotics, but between episodes she would have a dry, nonproductive cough. Results of system review were negative. As determined by physical examination the patient had dry eyes, dry mouth, numerous repaired dental caries, and supple neck without lymphadenopathy, thyromegaly, or enlarged salivary glands. Her pulmonary examination was remarkable for persistent rales heard over the left lower lobe. No wheezing was heard. Her heart examination was unremarkable. Abdominal examination was unremarkable. No lymphadenopathy was noted. There were no rashes. The results of complete blood cell count, chemistry profile, liver profile, urinalysis, thyroid profile, immunoglobulins, and complement studies were normal. The test results for, rapid plasmin reagin, human immunodeficiency virus, cryoglobulins, and cold agglutinins were negative. The sedimentation rate was 76. The protein electrophoresis showed increased a-2 and globulin. The antibody to nuclear antigens was 2+,