A 40-Year-Old Woman Comes to the Office Because of a 3-Month

A 40-year-old woman comes to the office because of a 3-month history of itchiness in both eyes. During this time, she has also had difficulty swallowing solid food. She is sexually active with her husband and has recently noticed increased pain with sexual intercourse. Medical history is unremarkable and she takes no medications. Her sister has vitiligo. Vital signs are within normal limits. Oropharyngeal examination shows dry mucous membranes and prominent tongue fissures. Ophthalmologic examination shows normal visual acuity and scleral injection in both eyes. A filter paper placed on the patient's lower eyelid wicks 3 mm of moisture after 5 minutes.   A salivary gland biopsy image representative of this patient's disease process is shown in the exhibit.  This patient is at greatest risk for which of the following due to her current condition?

A) Arterial and venous thrombosis
B) Atlantoaxial subluxation
C) Non-Hodgkin lymphoma
D) Renal arterial occlusion
E) Restrictive cardiomyopathy