Primary Sjogren’s syndrome presents as psychosis: a case report

Introduction and importance: Neuropsychiatric manifestations are common in primary Sjögren’s syndrome (pSS). Psychosis is rarely seen in adolescent patients. Here, we report a case of adolescent Sjögren’s syndrome that presented with psychotic symptoms. Azathioprine treatment improved the psychosis. Case presentation: Fifteen-year-old female presented to the Psychiatric Department with 1 week of headaches, abnormal behavior, insomnia, tremors, and suicidal ideation. She was treated with Azathioprine. Clinical discussion: Psychosis, characterized by delusions and hallucinations, can be idiopathic or secondary, particularly in autoimmune diseases like pSS. Adolescent cases show psychosis without lupus criteria, often linked to trauma or substance abuse, responding positively to immunosuppressive treatment for pSS. Conclusion: pSS should be considered in the differential diagnosis of adolescents with new-onset psychiatric manifestations, even in the absence of sicca symptoms. Psychiatric symptoms improved with Azathioprine treatment, suggesting that it is an effective treatment for these cases.