This is a 58-year-old Chilean patient who consulted our service with a 20-year history of Sjögren's syndrome. He was treated only with artificial urticaria.
She's got a smart kid and a sister with Sjögren's syndrome.
No use of medications or smoking.
No family history of digestive cancer.
Denies symptoms of gastrointestinal bleeding, abdominal pain, diarrhea, fatigue, or weight loss.
The patient was referred from Rheumatology to the Urology Department of Hospital Padtado due to the appearance of hyperpigmented bands in fingernails for 5 years, followed by nails.
Three years ago, brown macules had appeared in the oral mucosa associated with progressive periungual hyperpigmentation.
1.
On physical examination, the oral mucosa showed a coffee macula in the lower lip towards the left labial commissure.
In fingernails and toenails, periungual coffee macules were observed.
1.
Histopathology of the oral mucosa showed mild acanthosis and hypermelanoma.
In the dermoepidermal junction numerous melans were observed, with prominent capillaries in dermis.
1.
Laboratory tests showed mild leukemia (3,700/uL with 1,370/uL lymphocytes).
The rest of the blood count, erythrocyte sedimentation rate, thyroid hormones, plasma cortisol and ACTH were within the normal range.
Anti-Ro (43.7 U/mL) and anti-La (> 48 U/mL) antibodies were positive, as well as antinuclear antibodies (1/2560) with a mottled pattern.
Anti-dsDNA, anti-Sm and anticardiolipin antibodies were negative.
Rheumatoid factor, lupus anticoagulant and immunoglobulin quantification were within normal ranges.
High digestive endoscopy and colon endoscopy showed no significant presence of hyperpigmentation or other findings.
The patient is still under clinical follow-up, with no new lesions appearing.
