Ann Dermatol.  2010 Feb;22(1):99-101. 10.5021/ad.2010.22.1.99.

A Case of Sjogren's Syndrome That Presented with Alcohol-induced Purpura

• Cheong SH
• Han YJ
• Choi YW
• Myung KB
• Lee JS
• Choi HY

• KMID: 2172051
• DOI: http://doi.org/10.5021/ad.2010.22.1.99

Abstract

Sjogren syndrome (SS) is a systemic autoimmune disease that mainly affects the salivary and lacrimal glands. It may exist as a primary condition or in association with other systemic autoimmune diseases. Patients with SS usually complain of persistent dryness of the mouth and eyes and other features, including diverse general symptoms and cutaneous symptoms such as purpura. We report here on a case of 34-year-old woman who presented with purple non-blanching palpable purpura on both lower legs, and these lesions had developed soon after drinking alcohol 2 days previously. She had a 2 year history of repeatedly developing rashes in association with drinking alcohol. The physical examination showed dry eyes and dry mouth. The laboratory tests showed positivity for anti-Ro/SS-A antibody and RF and hyperimmunoglobulinemia. She was diagnosed as suffering with primary SS. Herein we report on a patient with primary SS and this patient initially presented with recurrent purpura in association with alcohol ingestion. Drinking alcohol had played a role as a possible aggravating factor for the cutaneous purpura of this patient with SS.

Keyword

Alcohol-induced purpura; Primary Sjogren syndrome

MeSH Terms

Adult
Autoimmune Diseases
Drinking
Eating
Exanthema
Eye
Female
Humans
Hypergammaglobulinemia
Lacrimal Apparatus
Leg
Mouth
Physical Examination
Purpura
Sjogren's Syndrome
Stress, Psychological

Figure

• 

  Fig. 1 Red non-blanching palpable purpura on both of her lower legs.

Reference

1. Pines A, Ben-Bassat I. Waldenstrom's hyperglobulinemic purpura: an unusual immune complex disorder. Clin Rheumatol. 1984. 3:263–266.

2. Waldenstrom J. Hyperglobulinemic purpura, chronic sialoadenitis and the Sjogren syndrome. Scand J Rheumatol Suppl. 1986. 61:139–141.

3. Katayama I. Clinical analysis of recurrent hypergammaglobulinemic purpura associated with Sjogren syndrome. J Dermatol. 1995. 22:186–190.

4. Sugai S, Shimizu S, Tachibana J, Sawada M, Yoshioka R, Hirose Y, et al. Hypergammaglobulinemic purpura in patients with Sjogren's syndrome: a report of nine cases and a review of the Japanese literature. Jpn J Med. 1989. 28:148–155.

5. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002. 61:554–558.

6. Ramos-Casals M, Anaya JM, Garcia-Carrasco M, Rosas J, Bove A, Claver G, et al. Cutaneous vasculitis in primary Sjogren syndrome: classification and clinical significance of 52 patients. Medicine (Baltimore). 2004. 83:96–106.

7. Stewart SH. Alcohol and inflammation: a possible mechanism for protection against ischemic heart disease. Nutr Metab Cardiovasc Dis. 2002. 12:148–151.

8. Przybilla B, Ring J. Anaphylaxis to ethanol and sensitization to acetic acid. Lancet. 1983. 1:483.

9. Alibrandi B, Parodi A, Varaldo G. Purpura due to ethanol. N Engl J Med. 1990. 322:702.

10. Chua IC, Aldridge CR, Finlay AY, Williams PE. Cutaneous IgA-associated vasculitis induced by alcohol. Br J Dermatol. 2005. 153:1037–1040.