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Key Clinical Message: This unique case report of primary Sjogren's syndrome (pSS) shows bilateral ptosis and significant periorbital edema, compromising vision. To avoid misleading diagnosis, antibody tests must be evaluated and interpreted in the context of clinical findings. Primary Sjögren's syndrome is an idiopathic, autoimmune disorder involving the lacrimal and salivary glands characterized by both localized and systemic manifestations including xerostomia and keratoconjunctivitis sicca. Myasthenia Gravis (MG) is also an autoimmune disorder characterized by the development of auto‐antibodies against nicotinic acetylcholine receptors that causes decreased muscle response to stimulation. It usually presents with ptosis and generalized body weakness. Ophthalmological involvement is common in both disorders but ptosis is very rarely seen in pSS. We report the case of a 27‐year‐old woman presenting to our clinic with the complaint of ptosis and eyelid swelling. She also had a positive anti‐acetylcholine receptor antibody test and her initial presentation mimicked Myasthenia Gravis. Her autoimmune workup revealed a positive titer of Anti Ro SSA antibodies. Myasthenia Gravis was ruled out on electrodiagnostic studies which showed no decremental response, and pSS was confirmed on lip biopsy. Our case highlights that it is important to interpret the antibody test results in the context of clinical findings as we can have spurious results in autoimmune diseases. Autoimmune conditions can have varying presenting complaints hence, clinical judgment should always overrule diagnostic investigations and should thus guide patient management. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to characterize the clinical presentation, results of serological and immunological tests and sociodemographic factors in the Pakistani Lupus population. Methods: This prospective, cross-sectional study was undertaken at the Clinic for Arthritis and Rheumatic Diseases, Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between January 2020 and June 2023, involving adult patients with SLE (classified based on 1997 revised ACR criteria). Demographic data, clinical and laboratory features, auto-antibody profile, disease duration, treatment history and organ damage (calculated by SLICC/ACR-DI) were recorded for all patients. Descriptive statistics and logistic regression analysis were performed for statistical assessment. Results: A total of 98 patients (94.9% females and 5.1% males) were enrolled in the study. The mean age of patients was 30.93±11.09 years while the mean duration of illness was 3.27±3.01years. The most commonly observed clinical manifestations were neuropsychiatric systemic lupus erythematosus in 84% of patients and mucocutaneous involvement (photosensitivity, mucosal ulcers, facial rash, alopecia and discoid lupus in 63.92%, 56.70%, 48.45%, 37.11% and 13.40% patients respectively). They were followed by serositis, arthralgias and renal involvement in 60.42%, 33.67% and 25% of patients respectively. Antinuclear antibody by indirect immunofluorescence was positive in all while anti-dsDNA was positive in 50% of patients. Conclusions: Fatigue was the most commonly recorded symptom while Neuropsychiatric SLE was the most commonly observed systemic manifestation in the Pakistani population followed by mucocutaneous involvement, serositis, arthralgias and renal involvement. Reasons for serious manifestations at initial presentation include deficiency of healthcare professionals trained in the field of Rheumatology and lack of awareness among patients. [ABSTRACT FROM AUTHOR]

Objective: To find the association between the patters of thrombocytopenia with the timings and patterns of plasma leakage in patients presenting with dengue hemorrhagic fever (DHF) during the dengue epidemic of 2019, in Rawalpindi city. Study Design: Cross-sectional study. Setting: Department of Medicine, District Headquarter Hospital, Rawalpindi, Pakistan. Period: August to November 2019. Material & Methods: In which patients who were labelled and managed as DHF on the basis of clinical presentation, positive serology and ultrasonic evidence of plasma leakage were included. Demographic profile, clinical features with duration of illness, laboratory investigations including serological markers (NS1, IgG and IgG) and ultrasonic findings were recorded on a self-structured performa and data was analyzed using SPSS v23.0. Results: Two hundred and ninety five patients with DHF were enrolled in the study. There were 2012 males and 83 females (male to female ration of 2.5:1). Mean age of all participants was 32.83 years. 50.5% of the cases were primary infection (based on serology), whereas 38.3% were secondary infection and 11.2% were triple negative infection. In 81.1% of the cases, plasma leakage occurred on the 4th to 7th day of illness. In these cases, platelet count was <40,000 cells/mm³ in 13.6% cases, between 40,000 cells/mm³ - 80,000 cells/mm³ in 50.8% cases and greater than 80,000 cells/mm³ in 35.5% cases. Amongst the 17.8% of cases where plasma leakage occurred between 8th to 10th days, 56.6% had platelet count greater than 80,000 cells/mm³, 22.6% has platelet count between 40,000 cells/mm³- 80,000 cells/mm³ and 20.8% had platelet count of less than 40,000 cells/mm³. Conclusion: Most people had plasma leakage at day 4-7 of illness, so needed more critical monitoring and admission at 4th to 7th day of illness, plasma leakage was observed more commonly in primary as compared to secondary infections and mostly at the day of leakage, platelet count was between 40,000 cells/mm³- 80,000 cells/mm³. Strict monitoring is required from the 4th day of illness to detect early signs of leakage to decrease the mortality and complications by dengue infection. [ABSTRACT FROM AUTHOR]