primary sjogren’s syndrome presented with sensory ataxia associated with bilateral hearing loss and dementia

primary sjorgen syndrome is one of the commonest autoimmune diseases with characteristic of involvement of lachrymal and salivary glands, but other organ involvements as peripheral and central nervous system are also possible. the reported case is a 23 year old lady presented with progressive sensory ataxia and weakness of four limbs, bilateral sensory hearing loss and cognitive impairment with minimental score equal to 15/30 since one year prior to admission with associated bilateral central corneal opacity, dry mouth and dry eyes. electro physiologic studies showed sensory motor axonal polyneuropathy . a biopsy of sural nerve and salivary glands of lower lip showed lymphocytic infiltration. serologic evidence showed positive anti ro (ss-b), negative hcv and hiv antibody, thereafter the diagnosis was confirmed and according to this diagnosis she received high dose of intravenous methyl prednisolon then both hearing loss and cognitive impairment improved partially (minimental score 21/30 ). at last, she underwent plasmapheresis and her sensory ataxia improved greatly.