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[(and mouth, fatigue, and arthritis of the PIP)-406.3 (joints of the)]TJ
0.0808 Tw 0 -1.2 TD
[(hands and the wrist joints of both hands. )54.9 (Abdominal ultra-)]TJ
0.19901 Tw T*
[(sonography revealed moderately enlar)17.8 (ged spleen with no)]TJ
0.02499 Tw T*
[(evidence of lymphadenopathy)64.9 (.)]TJ
-0.0062 Tw 1.2 -1.2 Td
(Laboratory investigations revealed normal sedimentation)Tj
-0.0032 Tw -1.2 -1.2 Td
[(rate, hemoglobin 13.6 g/dl, )17.8 (WBC 6970/mm)]TJ
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(3)Tj
-0.00011 Tc -0.0032 Tw 10 0 0 10 231.3376 653.1616 Tm
(, with 5% \(348\))Tj
0.02 Tc 0.62421 Tw -17.7338 -1.2 Td
(neutrophils, 91% lymphocytes; platelet count was)Tj
0 Tc 0 Tw T*
(138,000/mm)Tj
6.5 0 0 6.5 104.835 632.4615 Tm
(3)Tj
0.26961 Tw 10 0 0 10 108.0849 629.1616 Tm
(. Rheumatoid factor was 1:320, antinuclear)Tj
0.3564 Tw -5.4085 -1.2 Td
(antibody 1:320, antimicrosomal and thyroglobulin anti-)Tj
0.0843 Tw T*
(bodies 1:640 each; IgG and IgM anticardiolipin antibodies)Tj
0.01289 Tc 0.362 Tw T*
[(were slightly elevated. )17.7 (T)69.8 (ests for serum antibodies to)]TJ
-0.00011 Tc 0.11839 Tw T*
[(dsDNA, Sm, Ro, La, and RNP)-331.6 (were all negative, as were)]TJ
0.03999 Tw T*
[(tests for hepatitis B surface antigen, hepatitis C RNA, HIV)128.8 (,)]TJ
0.0992 Tw T*
[(and HTL)91.7 (V)91.9 (-1. Peripheral blood smear showed an increased)]TJ
0 Tc 0.0484 Tw T*
[(number of lar)17.8 (ge granular lymphocytes. Evaluation of the B)]TJ
0.15311 Tw T*
[(and )17.8 (T)-385.3 (lymphocyte subpopulations revealed an increase in)]TJ
0.02 Tc 0.5161 Tw T*
(the B cell subpopulation along with an abnormal)Tj
0 Tc 0.1931 Tw T*
[(helper/suppressor ratio of )17.7 (T)-425.4 (cells due to elevation in the)]TJ
-0.02451 Tw T*
(CD8+ cell count. Peripheral blood phenotype analysis of the)Tj
-0.00011 Tc 0.0995 Tw T*
[(T)-331.8 (cells was as follows: CD3 92%, CD8 84%, CD16 69%,)]TJ
0.22279 Tw T*
(CD56 33%, CD57 41%, CD19 7%, and HLA-DR 70%.)Tj
0 Tc 0.1297 Tw T*
(Bone marrow aspiration revealed normoblastic maturation)Tj
0.32449 Tw T*
(with dyserythropoietic features, decrease in granulocyte)Tj
0.0321 Tw T*
(population, and increase in the small lymphoid cell popula-)Tj
0.2056 Tw T*
(tion. Biopsy of the minor salivary glands showed acinar)Tj
-0.00011 Tc 0.1705 Tw T*
[(fibrosis surrounded by a few lymphocytic infiltrates. )17.7 (The)]TJ
0 Tc 0.173 Tw T*
(immunohistochemical study disclosed only few lymphoid)Tj
-0.0029 Tw T*
(cells, which stained positive for leukocyte common antigen,)Tj
0.02499 Tw T*
(CD3, CD4, and negative for CD57.)Tj
/TT1 1 Tf
-0.0002 Tc 0 Tw 0 -2.4 TD
(DISCUSSION)Tj
/TT0 1 Tf
-0.00011 Tc 0.0625 Tw 0 -1.2 TD
[(W)79.7 (e describe an association of primary SS with )17.7 (T)-294.8 (cell LGL)]TJ
0 Tc 0.1174 Tw T*
(in 2 patients and suggest that these disorders may share a)Tj
0.14349 Tw T*
[(common etiology)64.9 (. Classically)64.9 (, histopathological studies of)]TJ
0.0347 Tw T*
(the lacrimal and salivary glands of patients with SS display)Tj
0.10831 Tw T*
[(CD4+ )17.8 (T)-340.5 (and B cell infiltration)]TJ
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(1,9)Tj
0.10831 Tw 10 0 0 10 188.6288 293.1616 Tm
(. Of particular note is the)Tj
-0.00011 Tc 0.0956 Tw -13.4629 -1.2 Td
(observation of Fox, )Tj
/TT2 1 Tf
0 Tc 0.0955 Tw 8.3403 0 Td
(et al)Tj
/TT0 1 Tf
0 Tw 6.5 0 0 6.5 155.8529 284.4616 Tm
(9)Tj
0.0955 Tw 10 0 0 10 162.558 281.1616 Tm
(that the lymphocytes infiltrating)Tj
0.21359 Tw -10.8558 -1.2 Td
(the salivary glands in SS lack CD57 \(Leu-7\) and CD16)Tj
0.1814 Tw T*
[(\(Leu-1)36.9 (1\) antigens, which are present on peripheral blood)]TJ
0.10271 Tw T*
(lymphocytes of the patients. By contrast, one of our cases)Tj
0.2697 Tw T*
(\(Case 1\) was unique with respect to the appearance of)Tj
-0.00011 Tc 0.2534 Tw T*
[(CD8+, CD57+ \(Leu-7\), and CD16+ \(Leu-1)36.8 (1\) )17.7 (T)-485.7 (cells, a)]TJ
0 Tc -0.0229 Tw T*
[(finding compatible with the LGL)-190.2 (found in the salivary gland)]TJ
0.1615 Tw T*
[(biopsy)64.9 (. In addition, we found a striking phenotypic simi-)]TJ
0.09151 Tw T*
[(larity between the LGL)-304.7 (cells in the peripheral blood, bone)]TJ
0.02499 Tw T*
[(marrow)64.9 (, and salivary gland.)]TJ
-0.00011 Tc 0.1142 Tw 1.2 -1.2 Td
[(This association of primary SS with CD3+ )17.8 (T)-346.4 (cell LGL)]TJ
0 Tc 0.084 Tw -1.2 -1.2 Td
(raises the possibility of a common etiology for both disor-)Tj
0.0267 Tw T*
[(ders. )54.9 (Although the etiology of SS is unclear)39.8 (, several studies)]TJ
0.28169 Tw T*
[(have associated SS with viral etiology)65 (, such as EBV)]TJ
0 Tw 6.5 0 0 6.5 285.0001 128.4616 Tm
(10)Tj
10 0 0 10 291.5001 125.1616 Tm
(,)Tj
0.0029 Tw -23.75 -1.2 Td
(hepatitis C)Tj
-0.0567 Tc 0 Tw 6.5 0 0 6.5 97.0787 116.4616 Tm
(11)Tj
-0.00011 Tc 0.0029 Tw 10 0 0 10 103.21 113.1616 Tm
(, or retroviruses)Tj
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(12)Tj
-0.00011 Tc 0.00301 Tw 10 0 0 10 172.7911 113.1616 Tm
(. Of particular similarity is the)Tj
0.0255 Tw -11.8791 -1.2 Td
[(HIV)-257.8 (associated dif)17.7 (fuse infiltrative lymphocytosis syndrome)]TJ
0 Tc -0.0094 Tw T*
(\(DILS\), in which the lymphocytic infiltration of the salivary)Tj
0.14909 Tw T*
(and lacrimal glands are of the CD3+, CD8+, and CD57+)Tj
0 Tw 26.4 63.5093 Td
(phenotype)Tj
6.5 0 0 6.5 359.6553 715.5551 Tm
(13,14)Tj
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[(, suggesting that SS associated LGL)-256.3 (could be)]TJ
0.02499 Tw -5.628 -1.2 Td
(an autoimmune reaction to an undefined retrovirus.)Tj
-0.02609 Tw 1.2 -1.2 Td
[(T)69.8 (o our knowledge, this is the first report of an association)]TJ
-0.00011 Tc 0.09731 Tw -1.2 -1.2 Td
[(of classical SS with )17.8 (T)-329.5 (cell LGL. Moreover)39.7 (, our finding of)]TJ
0 Tc -0.00661 Tw T*
[(LGL)-206.6 (infiltration of the salivary glands of one of our patients)]TJ
0.0452 Tw T*
(raises the possibility that SS in this case has been preceded)Tj
0.1532 Tw T*
[(or caused by glandular infiltration of LGL)-366.4 (cells, and that)]TJ
0.0078 Tw T*
(both disorders may constitute an autoimmune reaction to an)Tj
-0.00011 Tc 0.02499 Tw T*
(undefined retrovirus.)Tj
/TT1 1 Tf
0 Tw 0 -2.4 TD
(ACKNOWLEDGMENT)Tj
/TT0 1 Tf
0 Tc 0.1844 Tw 8 0 0 8 318 582.2551 Tm
(The authors thank Charlotte Sachs and Gloria Ginzach of the Editorial)Tj
0.0249 Tw 0 -1.25 TD
[(Board, Beilinson Campus, Rabin Medical Center)39.8 (, for their assistance.)]TJ
/TT1 1 Tf
-0.00011 Tc 0 Tw 10 0 0 10 318 548.2551 Tm
(REFERENCES)Tj
/TT0 1 Tf
0.02499 Tw 8 0 0 8 325 538.2551 Tm
[(1.)-875.1 (Adamson )17.7 (TC III, Fox RI, Frisman OM, Howell FU.)]TJ
0 Tc 1.675 -1.25 Td
(Immunohistologic analysis of lymphoid infiltrates in primary)Tj
T*
[(Sj\366gren\222)54.9 (s syndrome using monoclonal antibodies. J Immunol)]TJ
0 Tw T*
(1983;130:203-8.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(2.)-875.1 (Zumla )54.8 (A, Mathus M, Stewart J, )17.7 (W)39.7 (ilkinson L, Isenber)17.7 (g D. )17.7 (T)-257.3 (cell)]TJ
1.675 -1.25 Td
[(receptor expression in Sj\366gren\222)54.8 (s syndrome. )54.8 (Ann Rheum Dis)]TJ
0 Tc 0 Tw T*
(1991;50:691-3.)Tj
0.0249 Tw -1.675 -1.25 Td
[(3.)-875 (Ramakrishna R, Chaudhuri K, Stur)17.8 (gess )54.8 (A, Manoharan )54.8 (A.)]TJ
-0.00011 Tc 1.675 -1.25 Td
[(Haematological manifestations of primary Sj\366gren\222)54.8 (s syndrome: )54.8 (A)]TJ
0 Tc T*
[(clinicopathological study)64.9 (. Q J Med 1992;84:547-54.)]TJ
-0.00011 Tc -1.675 -1.25 Td
[(4.)-875.1 (Lougham )17.7 (TP)-238.2 (Jr)54.8 (. Clonal diseases of lar)17.7 (ge granular lymphocytes.)]TJ
0 Tc 1.675 -1.25 Td
(Blood 1993;82:1-14.)Tj
-1.675 -1.25 Td
[(5.)-875 (Sivakumaran M, Richards S. Immunological abnormalities of)]TJ
1.675 -1.25 Td
[(chronic lar)17.8 (ge granular lymphocytosis. Clin Lab Haematol)]TJ
0 Tw T*
(1997;19:57-60.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(6.)-875.1 (Gentile )17.7 (TC, )17.7 (W)79.7 (ener MH, Starkebaum G, Loughram )17.7 (TP)-238.2 (Jr)54.8 (. Humoral)]TJ
0 Tc 1.675 -1.25 Td
[(immune abnormalities in )17.7 (T)91.8 (-cell lar)17.8 (ge granular lymphocyte)]TJ
T*
[(leukemia. Leukemia L)54.9 (ymphoma 1996;23:365-70.)]TJ
-1.675 -1.25 Td
[(7.)-875 (W)79.8 (allis )17.7 (WJ, Loughram )17.7 (TP)-238.1 (Jr)39.8 (, Kadin ME, Clark EA, Starkebaum)]TJ
1.675 -1.25 Td
[(GA. Polyarthritis and neutropenia associated with circulating lar)17.8 (ge)]TJ
T*
[(granular lymphocytes. )54.9 (Ann Intern Med 1985;103:357-62.)]TJ
-1.675 -1.25 Td
[(8.)-875 (Bowman SJ, Sivakumaran M, Snowden N, et al. )17.7 (The lar)17.8 (ge granular)]TJ
1.675 -1.25 Td
(lymphocyte syndrome with rheumatoid arthritis. Immunogenetic)Tj
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[(evidence for a broader definition of Felty\222)54.9 (s syndrome. )54.8 (Arthritis)]TJ
T*
(Rheum 1994;37:1326-30.)Tj
-1.675 -1.25 Td
[(9.)-875 (Fox RI, Hugli )17.7 (TE, Lanier LL, Mor)17.8 (gan EL, Howell F)79.8 (. Salivary gland)]TJ
1.675 -1.25 Td
[(lymphocytes in primary Sj\366gren\222)54.9 (s syndrome lack lymphocyte)]TJ
T*
[(subsets defined by Leu-7 and Leu-1)36.8 (1 antigen. J Immunol)]TJ
0 Tw T*
(1985;135:207-14.)Tj
0.0249 Tw -2.175 -1.25 Td
[(10.)-875 (Saito I, Servenius B, Compton )17.7 (T)74 (.)0.1 ( Detection of Epstein-Barr virus)]TJ
2.175 -1.25 Td
[(DNA)-220.1 (by polymerase chain reaction in blood and tissue biopsies)]TJ
-0.00011 Tc T*
[(from patients with Sj\366gren\222)54.8 (s syndrome. J Exp Med 1989;)]TJ
0 Tc 0 Tw T*
(169:2191-8.)Tj
0.0249 Tw -2.1381 -1.25 Td
[(1)36.9 (1.)-875 (Haddad J, Deny P)110.8 (, Mung-Gotheil C, et al. L)54.9 (ymphocytic sialadenitis)]TJ
2.1381 -1.25 Td
[(of Sj\366gren\222)54.9 (s syndrome associated with chronic hepatitis C virus)]TJ
T*
(liver disease. Lancet 1992;339:321-3.)Tj
-0.00011 Tc -2.175 -1.25 Td
[(12.)-875.1 (T)69.7 (a)-0.1 (lal N, Dauphinee MJ, Dang H, )54.8 (Alexander SS, Hart DJ, Garry RF)79.7 (.)]TJ
0 Tc 2.175 -1.25 Td
(Detection of serum antibodies to retroviral proteins in patients with)Tj
T*
[(primary Sj\366gren\222)54.9 (s syndrome. )54.8 (Arthritis Rheum 1990;33:774-81.)]TJ
-2.175 -1.25 Td
[(13.)-875 (Itescu S, Brancato LJ, Buxbaum J, et al. )54.8 (A)-219.8 (dif)17.8 (fuse infiltrative CD8)]TJ
2.175 -1.25 Td
(lymphocytosis syndrome in human immunodeficiency virus)Tj
-0.00011 Tc T*
[(infection: )54.8 (A)-219.9 (host immune response associated with HLA-DR5. )54.8 (Ann)]TJ
0 Tc T*
[(Intern Med 1990;1)36.9 (12:3-10.)]TJ
-2.175 -1.25 Td
[(14.)-875 (Itescu S, Dalton J, Zang H-Z, )17.7 (W)39.8 (inchester R. )17.7 (T)34.9 (issue infiltration in a)]TJ
2.175 -1.25 Td
(CD8 lymphocytosis syndrome associated with human)Tj
T*
(immunodeficiency virus-1 infection has the phenotypic appearance)Tj
T*
(of an antigenically driven response. J Clin Invest 1993;91:2216-25.)Tj
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