What are the symptoms of Sjögren’s syndrome in a 19-year-old?

Question

Hello doctor,

I am 19 years old with chronic dry mouth and eyes, jaw clicking and pain, fatigue, difficulty swallowing, and blue nails. A biopsy showed grade 2 sialadenitis (Chisholm and Mason). The ENA panel was negative, except for borderline anti-DSF70. Could this be seronegative Sjögren’s syndrome?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Based on your symptoms, chronic dry mouth and eyes, jaw pain and clicking, fatigue, difficulty swallowing, and blue-tinged nails along with a labial salivary gland biopsy showing grade 2 sialadenitis (Chisholm and Mason), there is a strong clinical suspicion for seronegative Sjogren’s disease, even though your extractable nuclear antigen (ENA) panel is negative and anti-dense fine speckled 70 (anti-DFS70) is only borderline (value 9).

While typical Sjögren’s syndrome involves positive anti-Sjögren’s syndrome-related antigen A (anti-SSA/Ro) or anti-Sjögren’s syndrome-related antigen B (anti-SSB/La) antibodies, a subset of patients, especially younger individuals, can present with the disease despite negative serology, and the biopsy finding supports this possibility. Additional supportive features like Raynaud’s phenomenon (suggested by blue nails), fatigue, and sicca symptoms further point toward Sjögren’s disease. It is important to follow up with a rheumatologist for a full evaluation, as early recognition and management can help prevent complications and improve quality of life.

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.