[Delayed Diagnosis of Primary Sjögren's Syndrome presenting as Atypical Migraine - A Case Report].

INTRODUCTION

Primary Sjögren's Syndrome usually presents with Sicca symptoms but may initially manifest with non-specific neurological complaints such as migraine, paresthesia or dizziness.

HISTORY: A 34-year-old woman reported recurrent headaches, dizziness, and a single episode of mild aphasia; she was initially diagnosed with migraine without aura. Despite stage-appropriate therapy, additional symptoms such as dry mouth and eyes as well as arthralgia developed.

FINDINGS AND DIAGNOSTICS: Cranial imaging was unremarkable. Orbital Doppler sonography revealed widened optic nerve sheaths. Autoimmune serology was positive for ANA, ENA, and Anti-SSA antibodies. Schirmer test, tear film break-up time, and salivary flow confirmed sicca syndrome.

THERAPY AND COURSE: After diagnosis, treatment with prednisolone and hydroxychloroquine was initiated, leading to a significant improvement in neurological and extraglandular symptoms. Pilocarpine along with supportive eye and oral care improved the sicca symptoms.

CONCLUSION

Non-specific neurological symptoms may represent early in Primary Sjögren's Syndrome, highlighting the importance of early serological testing and interdisciplinary evaluation.