Alpha1 antitrypsin phenotypic variability is not associated with ANCA in southern Chinese.

salivary gland tissue. Additionally, thyroid function tests showed a raised thyroid stimulating hormone (11 mU/l), low free thyroxine 4 (13.0 pmol/l) with positive antithyroid microsomal antibodies and negative antithyroglobulin antibodies. The clinical, serological, and histopathological manifestations fulfilled the European study group criteria for the diagnosis of SS. The patient was treated with artificial tears and thyroxine supplements that returned her thyroid function tests to normal. Prevalence of neuropathy in patients with SS ranges from 10 to 50%. Polyneuropathy can be the first clinical manifestation of SS and may even precede sicca symptoms in 40% of patients. However, less frequently, cranial neuropathy can occur with a predisposition to involvement of the trigeminal nerve. The vasculitic damage to vaso nervorum documented by pathological studies is associated with a higher incidence of serum anti-SS-A (Ro) antibodies. The association of SS with autoimmune thyroid disease (AITD) is well recognised. 7 AITD and SS share similarities in the immunopathology in addition to their genetic linkage to the HLADR3/DR4 alleles. Only nine cases of facial nerve involvement associated with SS have been described previously. 8–10 This case illustrates how facial palsy disclosed the primary SS as an underlying systemic disorder. To our knowledge the combination Bell’s palsy as presenting feature in a patient with SS, and hypothyroidism secondary to AITD has not been reported hitherto.