A case report of Sjogren syndrome manifesting bilateral basal ganglia lesions

Rationale: Peripheral neurological complications in primary Sjogren's syndrome (pSS) seem the most common, however the involvement of central nervous system (CNS) remains unclear. While abnormalities in pSS revealed by brain magnetic resonance imaging (MRI) are usually small discrete hyperintense areas in the white matter on T2-FLAIR weighted MRI, massive brain lesions have been rarely reported, particularly in bilateral basal ganglia. Patient concerns: A 51-year-old woman exhibited dizziness, slurred speech and hemiplegia as a manifestation of pSS. Brain MRI revealed bilateral and symmetrical lesions extending into the basal ganglia, corona radiata and corpus callosum. Diagnoses: Primary Sjogren's syndrome was diagnosed on the basis of clinical features, abnormal Schirmer's test and tear breakup time (BUT) findings, high levels of anti-Sjogren's-syndrome-related antigen A (anti-SSA) (Ro) and anti-Sjogren's-syndrome-related antigen B (anti-SSB) (La) antibodies, and positive labial minor salivary gland biopsy results. Interventions: She was treated with intravenous methylprednisolone and discharged on oral steroid therapy of prednisolone acetate. Outcomes: The patient had an excellent response to steroid therapy. Lessons: The present case suggests that symmetry bilateral lesions can occur as a symptom of pSS, which could be induced by an autoimmune mechanism.