Cervical spondylodiscitis in a patient with ankylosing spondylitis.

Our patient had been receiving the drug for ~ 3 yr and her sicca symptoms became rather profound over recent months, associated with severe swelling of the parotids. It is difficult to be certain about how long she had had positive serology for the Ro antibody in her blood as it was tested soon after the development of the sicca symptoms. Although anti-Ro is commonly associated with various connective tissue diseases, none of these were present on clinical examination. The clinical presentation of our patient had raised several possibilities, including metastatic carcinoma, but the lymph node biopsy finding was reassuring as it had no evidence of secondaries or primary lymphoreticular malignancy. The lymph node biopsy showed no evidence of focal necrosis, or eosinophilic or histiocytic cell infiltrate which is a characteristic feature of PLS [2-5]. It was most interesting to note the transient serological abnormality, which took ~3 months to become normal together with complete resolution of her symptoms. The dramatic effect of withdrawal of the drug on the size of her parotid glands was also remarkable. Our case highlights problems in many areas of clinical management, including multiple unproven diagnoses, polypharmacy and perhaps indiscreet duration of therapy. An aggressive but cautious approach to the reduction of steroid had met with no untoward effect and she remains well at a considerably lower dose of steroid. Her blood glucose control is very much improved and it is possible that she may not require any anti-hypertensive therapy in future. To our knowledge, this is the first case of pseudo-Sjogren's syndrome associated with phenytoin therapy and rheumatologists should be aware of this reversible clinical entity. K. CHAKRAVARTY, M. S. AI-JAFARI* Departments of Rheumatology and *Histopathology, Warrington Hospital NHS Trust, Warrington, Cheshire Accepted 30 April 1996 Correspondence to: K. Chakravarty, Old Church Hospital, Waterloo Road, Romford, Essex, RM7 OBE.