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Thank you very much for listening to the first part of my talk.
For the second part, we would like to pick up on further exploring the clinical spectrum of disease,
and we will highlight lymphoproliferative disorders, vasculitis,
GYN issues including pregnancy and neuropathies,
along with checkpoint inhibitors and clinical development programs.
I'd like to present a case that brings us into the next category of extra-glandular manifestations, and this is a case of mine.
A 42-year old mother-of-three, who has mild dry eye, but still wears contacts.
She has pretty significant fatigue (but that's often been accounted for by being a busy mom),
a little bit of joint pain, and she has a persistently enlarged right submandibular gland.
She has a little bit of cervical adenopathy, that is more prevalent on the right side than the left.
Historically, she's had two previous episodes of cutaneous vasculitis, that was quite responsive to steroids.
She is being maintained on hydroxychloroquine 200 milligrams per day,
and an NSAID (meloxicam) that she takes occasionally for her joint pain.
On exam she had a right submandibular gland that was 2cm, was very firm, with surrounding skin erythema.
As stated, the cervical adenopathy was more prevalent on the right than the left.
She had no synovitis on exam.
Lab exam showed as SSA-positive/rheumatoid factor-positive, and IgG that was elevated.
Inflammatory markers, however, were normal.
C4 level was slightly decreased, but she had a monoclonal IgMκ on IEP.