We report the case of a 70-year-old man diagnosed with late-onset Wilson disease (WD) with mild neurological symptoms only and a new mutation in the ATP7B gene. A compound mutation of the ATP7B gene was found with the variant c.98T>C p(Met33Thr) in exon 2, in heterozygosis, and variant c.2224G>A (Val742Ile) in exon 8, in heterozygosis. Patient age should not be a determinant for excluding WD. Genetic sequencing is an important tool for the discovery of new genetic mutations.

A 72-year-old man with hypertension came to our hospital with a history of severe posterior chest pain 3 months ago and worsened 1 week before admission. He denied a history of recent trauma but was admitted with dengue infection 3 months ago and was diagnosed with Gleason 3 + 4 prostatic adenocarcinoma in the same period. The patient was taking chlorthalidone, enalapril, bicalutamide, and morphine for pain relief. On admission examination, pain on palpation of the thoracic and lumbar spine was noticed.

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BACKGROUNDSjögren's syndrome is a chronic multisystem autoimmune disease characterized by inflammation of the lacrimal and salivary glands, in addition to variable systemic manifestations, such as fatigue, musculoskeletal symptoms and involvement of internal organs. Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranging from asymptomatic contamination to a severe acute respiratory disease with the possibility of long-term consequences. We aim to describe a case of Sjögren's syndrome started after an infection by SARS-CoV-2. CASE REPORTA 32-year-old woman with a history of low fever, oppressive headache, nausea, abdominal pain and diarrhea, with later onset of dyspnea, self-limited, a lasted for about seven days. Reverse transcription polymerase chain reaction (RT-PCR) was collected for COVID-19 by nasopharyngeal swab, the result of which was positive. About 20 days after improvement of the initial symptoms, she developed a feeling of dry mouth and eyes and altered bowel habit, alternating periods of diarrhea, without characteristics of invasion, self-limited, with constipation, recurrent and progressive condition. Subsequently, she evolved with diffuse myalgia and paresthesia in the distal segment of the lower and upper limbs, sometimes also affecting the perioral region. She has a positive personal history for Hashimoto's thyroiditis and a significant family history for autoimmune diseases, with a mother with Sjögren's syndrome and a brother with type 1 diabetes mellitus. The physical examination showed only palpable lymph nodes, submental and submandibular, small, mobile and not adhered to. Laboratory exams show 1/80 fine speckled nuclear pattern (antinuclear antibody) ANA and anti-Ro reagent, with a 240 titer, positive anti-TPO, but with other normal inflammatory markers and autoantibodies. Ophthalmological evaluation with Schirmer's test resulted in inflammatory dry eye. The patient was diagnosed with Sjögren's syndrome. In view of the close temporal relationship, the hypothesis of COVID-19 was considered as a triggering factor for autoimmune disease. Treatment with hydroxychloroquine 400 mg, artificial saliva and lubricating eye drops was started.