Sjögren’s syndrome in a child presenting with cutaneous findings

Objectives A 12-year-old girl was admitted to our hospital due to large erythematosus lesions on pretibial region that has been seen for three years. These lesions were started with hyperemic, tender and nodular forms then changed to a dark brown macular coloration and persists afterward. She did not suffer from dry mouth or eye. However, when the medical history was examined carefully, she pointed out that she had no teardrops. Erythrocyte sedimentation rate (ESR) was 43 mm/hour, C-reactive protein (CRP) was 0.43 mg/dl, antinuclear antibody test was 1/320 (+), anti-Ro and RF was positive and anti-La was negative. She had bilateral positive Schirmer test (2mm/ 2mm). Biopsy of the salivary gland revealed lymphocytic infiltration. With positive Schirmer test, positive anti-Ro antibody and ANA and supportive biopsy findings, the diagnosis of SS was established. She was started 200 mg/ day hydroxycholoquine andsymptomatic therapy with eye drops.