[Primary biliary cirrhosis, rheumatoid arthritis and Sjögren's syndrome following implantation of ventriculoperitoneal shunt tube--an aged male case report].

A 73-year old male was received implantation of ventriculoperitoneal shunt tube (made with silicone) following subarachnoid hemorrhage in March 1991. Alkaline phosphatase was elevated gradually and he was diagnosed as having primary biliary cirrhosis by antimitochondria antibody and liver biopsy. He had been taking urso acid after that time on. He was admitted to our hospital because of stiffness and edema of both hands in November 1993. He was diagnosed as rheumatoid arthritis by morning stiffness with duration of few hours bilateral swelling of metacarpal, proxymal intrapharangeal and wrist joints and positive rheumatoid factor. In addition he felt dry mouth and laboratory data revealed that antinuclear antibody was 640x, centromere type, anti-SS-A antibody positive and elevation of circulating immune complex. A salivary gland disfunction was showed by gum test and salivary gland scintigraphy. Therefore the diagnosis of Sjögren's syndrome was made also. Connective tissue diseases have been reported to occur following cosmetic surgery with injection of the foreign substances paraffin and silicone. Now it is supposed to be the first case tcat connective tissue disease following ventriculoperitoneal shunt tube implantation.