{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:53:45Z","timestamp":1777312425253,"version":"3.51.4"},"reference-count":38,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Systemic lupus erythematosus (SLE) and Sj\u00f6gren\u2019s syndrome (SS) are chronic autoimmune diseases that can coexist, complicating the diagnostic process due to overlapping clinical and serological features. Hypergammaglobulinemia, often associated with these conditions, can mimic hematological malignancies, posing a significant diagnostic challenge.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case Presentation:<\/jats:bold>\n                    We report a case of a 57-year-old woman presenting with progressive fatigue, dry cough, and vasculitic rashes for several weeks. Initial laboratory results revealed pancytopenia, hypergammaglobulinemia, and elevated inflammatory markers (erythrocyte sedimentation rate (ESR) &gt;100 mm\/hr, C-reactive protein (CRP) 137.7 mg\/L), raising suspicion for multiple myeloma. However, protein electrophoresis (which showed polyclonal rather than monoclonal globulinemia) and bone marrow biopsy excluded malignancy. Further autoimmune screening confirmed coexisting SLE and SS, with positive ANA (\u22651:1280), anti-dsDNA, anti-Ro, and anti-La antibodies. Polyclonal hypergammaglobulinemia was attributed to these autoimmune conditions. The patient responded well to azathioprine and hydroxychloroquine, with significant clinical and biochemical improvement.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Discussion:<\/jats:bold>\n                    This case highlights the importance of distinguishing polyclonal hypergammaglobulinemia due to autoimmune diseases from monoclonal gammopathies such as multiple myeloma. Early autoimmune screening and multidisciplinary collaboration were essential in achieving an accurate diagnosis and appropriate management.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Polyclonal hypergammaglobulinemia in the presence of elevated inflammatory markers warrants a thorough differential diagnosis to distinguish autoimmune conditions from hematological malignancies. This case underscores the critical role of comprehensive autoimmune screening in guiding timely and accurate diagnosis.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.91","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T11:30:37Z","timestamp":1757935837000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic dilemma: Differentiating coexisting systemic lupus erythematosus and Sj\u00f6gren\u2019s syndrome mimicking multiple myeloma in a patient with hypergammaglobulinemia presenting to primary care \u2013 A case report"],"prefix":"10.5339","volume":"2025","author":[{"given":"Zhila","family":"Mohammed","sequence":"first","affiliation":[{"name":"Master\u2019s in Assisted Reproductive Technology (University of Nottingham, UK) College of Medicine, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zozik","family":"Fattah","sequence":"additional","affiliation":[{"name":"Consultant Rheumatologist Mediclinic City Hospital, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6342-7829","authenticated-orcid":true,"given":"Anas","family":"Kalfah","sequence":"additional","affiliation":[{"name":"Resident Doctor, Medical Education Department Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4003-4216","authenticated-orcid":true,"given":"Alan","family":"Saeed","sequence":"additional","affiliation":[{"name":"Consultant Family Physician [MBChB, FRCP (UK), MRCGP (UK), MRCP (Diabetes & Endocrinology), DFSRH] Primary Health Care Corporation, Doha, Qatar*Address for Correspondence: Alan Saeed alsaeed@phcc.gov.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"Front Immunol","first-page":"611","article-title":"Gender bias in human systemic lupus erythematosus: A problem of steroid receptor action?","volume":"9","author":"Rider\n \nV","year":"2018"},{"issue":"(1):","key":"CIT0002","series-title":"Best Pract Res Clin Rheumatol","first-page":"105\u201317","article-title":"Sj\u00f6gren\u2019s syndrome, the old and the new","volume":"26","author":"Peri\n \nY","year":"2012"},{"issue":"(7):","key":"CIT0003","series-title":"J Clin Pathol","first-page":"481\u201390","article-title":"Pathogenesis of systemic lupus erythematosus","volume":"56","author":"Mok\n \nCC","year":"2003"},{"issue":"(2):","key":"CIT0004","series-title":"Rheumatology (Oxford)","first-page":"525\u201333","article-title":"SMART-SLE: Serology monitoring and repeat testing in systemic lupus erythematosus\u2014an analysis of anti-double-stranded DNA 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