A 55-year-old woman with established Sjögren syndrome develops persistent unilateral parotid enlargement, cervical nodes, palpable purpura, low C4

Question

A 55-year-old woman with established Sjögren syndrome develops persistent unilateral parotid enlargement, cervical nodes, palpable purpura, low C4 and mixed cryoglobulins. Symptoms do not improve with antibiotics. Which next step is most appropriate?

Accepted Answer

Obtain tissue biopsy to evaluate for salivary-gland lymphoma

Answer

Order HLA-B27 testing as the initial lymphoma screening study

Answer

Increase artificial tears and reassess the gland in twelve months

Answer

Begin allopurinol because cryoglobulins indicate urate deposition

Answer

Attribute enlargement to benign sicca disease and reassess in one year

Sjögren syndrome — ABIM Board MCQ

A 55-year-old woman with established Sjögren syndrome develops persistent unilateral parotid enlargement, cervical nodes, palpable purpura, low C4 and mixed cryoglobulins. Symptoms do not improve with antibiotics. Which next step is most appropriate?