Dear Sir My wife 42 years was suffering from Adrenal insufficiency from Feb 2009 along with Hypo Thyroidism .Her ANA was positive since 2009 however she was doing fine till 15th Dec 2016 and she was on Wysolone 5 and Thyrox 88 (Dosage tapered from 25-50-75--88 (recently)}in last 7 years. On.16. December 2016. Her Blood pressure got elevated to 234/ 134 and when we admitted her into Hospital .Her Creatinine was 3.4 which has gone UpTo 5.44 and with 3 shots of pulse steroids like Methyl prednisolone and one Immunosuppressant drug Cyclophosphamide it came down to 3.67 which is again increasing now and reach to 4.40 on 12th Jan 2017. Her Platelet were approx 46000 at the time of admission which dipped to 22000 and after that she was administered 3 SDP and 1 unit of blood and Platelet reached to 1.22 Lakhs. However again it came down to 19000 few days back and it was 42000 on 12th Jan 2017 Already 5 sessions of Plasmapheresis has happened Report of bone marrow biopsy is awaited. Doctors Panel (comprising of 2 nephrologist 1 Rheumatologist Hematologist) were discussing the idea of adding rituximab however she got some lung infection--they have differed the decision until infection is over. Blood Pressure is fluctuating since last one month--Systolic---(120--200) and dystolic (80--110) even after 4 drugs from last 30 days. Please advise Imp--sjogren syndrome is confirmed through APAP reports and ANA profile is strongly positive for SS-A.