A patient with rheumatoid arthritis complicated by Sjögren's syndrome that was possibly caused by reactivation of Epstein-Barr virus.

A 24-year-old woman developed rheumatoid arthritis in 1986. Anti-SS-A antibody was negative, and Sjogren's syndrome was not associated with the disease. In July 1988 the patient developed pyrexia and cervical lymph node swelling. Infectious mononucleosis was suspected, and a previous contact with Epstein-Barr virus (EBV) was indicated. Pyrexia and cervical lymph node swelling occurred repeatedly and after this dry eyes and mouth also developed. In May 1990 the patient again developed pyrexia and cervical lymph node swelling, and she also had anti-SS-A antibodies (64×) and symptoms associated with Sjogren's syndrome. EBV antibody showed reactivation of EBV by the presence of viral capsid antigen-IgM antibody and a decrease in antibody titer against EBV-associated nuclear antigen. The clinical symptoms of repeated fever and cervical lymph node swelling, as well as the reactivation of EBV, suggest that EBV might have been a factor participated in the onset of Sjogren's syndrome in this patient.(Internal Medicine 32: 77-79 1993)