Primary Sjögren's Syndrome After Infectious Mononucleosis

To the Editor.—  Primary Sjögren's syndrome is an immune disorder consisting of keratoconjunctivitis sicca and dry mucosal surfaces without an associated connective-tissue disorder.¹ This disease has characteristic autoantibodies, HLA association, and glandular histopathology.^2-4 We have examined two patients with primary Sjögren's syndrome occurring after infectious mononucleosis.

Report of Cases.—Case 1.—  A 5-year-old girl had parotid gland swelling, fever, and pharyngitis. Her white blood cell count was 9200/mm³ (9.2×10⁹/L), with 7% (0.07) atypical lymphocytes. Epstein-Barr virus (EBV) titers one month after onset were as follows: viral capsit antigen (VCA) IgM, 1:40; VCA IgG, 1:320; and Epstein-Barr virus— associated nuclear antigen, 1:128. The serum IgG level was seven times normal and circulating immune complexes were present. Over the next two months, she was noted to have no tears when she cried. A Schirmer's test revealed 3 mm of wetting; 50% of the interpalpebral zone stained