Bilateral Parotid Enlargement Research Articles

Lack of pulmonary involvement leads to a 3 years delay of diagnosis in a childhood sarcoidosis case with arthritis, ocular symptoms, and bilateral parotid swelling

Key Clinical MessageThis paper presents a rare sarcoidosis case in a child of 12 years of age presented with arthritis, bilateral parotid enlargement and ocular, but unfortunately the diagnosis has been missed due to lack of pulmonary involvement.AbstractDiagnosis of sarcoidosis is by exclusion, and sometimes, it can be challenging. This paper presents a rare sarcoidosis case in a child of 12 years of age presented with bilateral parotid enlargement. The signs of musculoskeletal and ocular involvement were present before the parotid enlargement, and the parotid swelling persisted for 3 years; but unfortunately the definite diagnosis has been missed by the previous healthcare professionals most probably due to the rarity of the situation, especially lack of pulmonary involvement. Therefore, cooperation between different healthcare specialties is important for an effective diagnosis and management. Despite its rarity, sarcoidosis should always be present in the list of differential diagnosis when encountering multisystem entities like arthritis, ocular symptoms and parotid swelling.

Severe Headache in Primary Sjögren's Syndrome Responded to Rituximab.

Primary Sjögren syndrome (pSS) is an immune systemic disease, that may affect the central nervous system. A severe headache unresponsive to treatment is the headache which is persistently nonresponsive to narcotic analgesics. A 48-year-old woman with a 10-year history of pSS was seen in January 2021, complaining of a headache one week previously. The headache was characterised by a dull persistent pressing intensity and was not responding to paracetamol, NSAIDs or codeine. She had no previous history, nor family history. Physical examination revealed bilateral parotid glands enlargement. Laboratory tests showed anaemia, and elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), with positive anti-La and anti-Ro antibodies. She was given topical treatment and different doses of Predlone, in addition to methotrexate10 mg/week. She had received three pulses of methylprednisolone and was started on azathioprine with a mild response to the headaches, so she received two initial IV doses of rituximab 375 mg/m2, then every 2 weeks, with a clinical and laboratory response. Two years later, she had no headache. Headache that may presented in pSS are tension headaches, migraines and cluster headaches. The therapy is disease-modifying antirheumatic drugs, hydroxychloroquine, glucocorticoids and biotherapeutics. Rituximab is used in the treatment of some patients with pSS, especially where it can affect systemic symptoms. Rituximab treatment may be an option for severe headache in patients with pSS. The mechanism is unknown but may be due to depletion of brain auto-reactive B cells. Further research is needed. An unresponsive headache in a patient with primary Sjögren's syndrome treated with tryptophan, opioids and NSAIDs responded successfully to B-cell depletion with rituximab.We hypothesise that brain-autoreactive B cells were involved in the pathogenesis of the headache.

Eating disorders and the role of the dental team.

Although primarily classified as psychiatric disorders, eating disorders have a complex aetiology and presentation, with comorbidities spanning multiple disciplines, including dental complications. In some cases, general dental practitioners may be the first health professional to become aware that someone is struggling with an eating disorder. The dental team is in an ideal position to sensitively explore the presentation and signpost the patient to appropriate services while offering support and/or remedial management for dental complications of the eating disorder. Anyone from any background, gender or ethnicity may develop an eating disorder, of which the main diagnoses are anorexia nervosa, bulimia nervosa and binge eating disorder. Some of the frequently seen oral manifestations of these disorders include generalised dental erosion, caries, self-inflicted palatal or oropharyngeal trauma, atrophic mucosa, bilateral parotid gland enlargement, xerostomia and periodontal disease. The dentist's role is pivotal in recognising the possible implications of some of these findings, approaching the patient sensitively, and communicating empathetically to engage them in treatment, reducing the risk of further erosion and improving oral health and hygiene. The dental team may be able to signpost the patient to their general practitioner for onward referral or to a local eating disorder support network.

Primary Sjögren’s syndrome-related Choroiditis in a Newly Diagnosed Older Adult

ABSTRACT Purpose To report a case of secondary bilateral choroiditis in a patient with primary Sjögren’s syndrome(pSS). Study Design Case report. Results A 69-year-old woman visited our hospital for consultation due to decreased visual acuity in both eyes for 1 month. At the first visit, best corrected visual acuity (BCVA) was 0.2 and 0.3 in her right and left eyes, respectively. Intraocular pressure values were 15 mmHg and 16 mmHg in her right and left eyes, respectively. Examination revealed edema of the eyelids and conjunctiva,and corneal fluorescence staining was positive. No inflammation in the anterior chamber or vitreous opacities were observed. Bilateral multiple retinal detachments were observed on the posterior fundus, and optical coherence tomography revealed bilateral multiple areas of retinal neuroepithelial detachment, choroidal thickening, and choroidal folds. No abnormal fluorescence leakage was observed on fundus fluorescein angiography or indocyanine green angiography. In addition, systematic manifestations included recurrent bilateral parotid gland enlargement. Labial gland biopsy revealed dilated glandular ducts, scattered interstitial glands, and lymphocytic foci. Salivary gland scintigraphy revealed severe impairment of glandular excretory function. Moreover, blood tests for anti-Ro/SSA and anti-La/SSBantibodies were positive. The patient was diagnosed with primary Sjögren’s syndrome. After 2 months treatment with oral prednisolone acetate combined with hydroxychloroquine, her BCVAimproved to 0.8 and 1.0 in the right and left eyes, respectively. The fundus also recovered to normal, and no recurrence was observed during the 1-year follow-up period. Conclusions The current case highlights that pSS, which usually manifests with dry eye and keratoconjunctivitis, may manifest with chronic choroiditis in both eyes as well. Based on our experience with this case, patients with clinically suspected bilateral choroiditis should be evaluated for pSS.

LBSAT310 A Rare Disease Engulfing Thyroid And Masquerading As Common Thyroid Disorders

Abstract Introduction – Langerhans cell histiocytosis (LCH) is a rare clonal disorder caused by the CD207+ Langerhans cells derived from the myeloid origin. We present a case of LCH where it mimicked Hashimoto's and Riedel's thyroiditis and completely infiltrated the thyroid gland. Case description – A 54-year-old female was initially diagnosed with hypothyroidism, goiter, and bilateral parotid and submandibular glands enlargement. CT imaging revealed a diffuse goiter which imposed infraglottic airway narrowing and a suspicious left inferior thyroid nodule. Biopsy revealed atypia of undetermined significance. GSC showed a 50% suspicion of malignancy with a negative BRAF. Follow up imaging revealed increased infiltrative masses within the salivary glands, enlarging thyroid gland, and increased infiltration of the superior component of the right thyroid lobe into the submandibular space. A core needle biopsy revealed a background of acute and chronic inflammation without evidence of malignancy. Sjogren's, sarcoidosis and IgG4 diseases were ruled out. She was then referred to us after a myriad of work up. She had a diffusely enlarged goiter with a crusted area of skin over the thyroid gland and significant bilateral parotid swelling. We repeated a thyroid ultrasound which revealed diffusely enlarged and heterogeneous thyroid glands with pseudo-nodules and 3 suspicious nodules greater than 1cm on right and left lobes. She also had prominent reactive lymphadenopathy. Her submandibular glands were hypoechoic, avascular, markedly enlarged and abnormal appearing. She underwent total thyroidectomy. Pathology revealed proliferation of histiocytes, few islands of lymphoid tissue, and eosinophilic micro abscesses without any identifiable thyroid parenchyma in the entire resected specimens. Immunohistochemistry confirmed the diagnosis of Langerhans Cell Histiocytosis with atypical features. BRAF (V600E/V600K) mutation was again not detected. Flow cytometry showed no evidence of neoplastic myeloid blast population. She was referred to an oncologist for further management of LCH. Discussion – Our patient had a remarkably diffuse goiter with a sonographic appearance mimicking Hashimoto's thyroiditis or Riedel's thyroiditis. Initial thyroid FNA failed to reveal LCH. The diagnosis was reached only after total thyroidectomy. Treatment depends on single or multi-system involvement, presence or absence of risk organ involvement, and presence or absence of BRAF mutation. Conclusion In the cases of infiltrated thyroid diseases, Langerhans cell histiocytosis should be on the differential diagnosis, especially if there is concomitant infiltrative process in other organs. The sonographic finding can mimic Hashimoto's or Riedel's thyroiditis which may lead to misdiagnosis and treatment delay. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Sjögren Syndrome with Bilateral Multicystic Enlargement of the Parotids and Submandibular Glands

Sjögren's syndrome is an autoimmune disease. This means that the immune system attacks parts of your own body by mistake. It attacks the glands that produce tears and saliva. We report the case of a 51 -year-old woman who presented with bilateral parotid gland enlargement as the initial manifestation of primary Sjögren syndrome.

Prostate abscess with acute urinary retention as the initial presentation of granulomatosis with polyangitis

A 50-year-old male presented with acute urinary retention. He also had a history of cough, haemoptysis, exertional dyspnoea, loss of appetite, generalised weakness and left-ear discharge of 1-month duration. Prior episode of acute urinary retention had occurred 2 months ago; diagnostic evaluation revealed prostate abscess, and he had received treatment elsewhere for the same. He also had a history of hypertension. Physical examination revealed fever, pallor, bilateral parotid enlargement and left-ear serous discharge. Clinical examination, imaging of chest revealed consolidation with cavitation on the left side, bilateral pleural effusion. Laboratory testing revealed normocytic normochromic anaemia (haemoglobin 6.6 g/dL); neutrophilic leucocytosis (total leucocyte count 13,100 cells/mm3; polymorphs 87%); raised erythrocyte sedimentation rate (110 mm at the end of the first hour); elevated serum creatinine (2.69 mg/dL) and an active urine sediment. Flexible fibreoptic bronchoscopy showed alveolar haemorrhages. Bronchoalveolar lavage fluid Xpert MTB/RIF testing, cytopathology were negative. Computed tomography-guided biopsy from the lesion was suggestive of granulomatous vasculitis. Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) tested positive. The patient was diagnosed to have granulomatosis with polyangitis (GPA). As arterial hypoxaemia was evident, tracheal intubation and mechanical ventilatory support were initiated. Renal replacement therapy, intravenous (iv) methyl prednisolone and cyclophosphamide pulse therapy and five sessions of plasmapheresis were administered. As remission could not be achieved, iv rituximab was started. On the 36th day of admission, the patient developed septic shock and died. The present case documents the uncommon association of GPA with prostate abscess, acute urinary retention.

Bilateral parotid gland enlargement as a presenting manifestation of relapsed pediatric acute myeloid leukemia

Parotid gland involvement is a rare presentation of Acute Myeloid Leukemia (AML). We report a 10-year-old girl of acute myelomonocytic leukemia with normal cytogenetics and positivity for inversion 16, who after completion of first consolidation of the BFM 2004 AML protocol, presented with bilateral parotid gland enlargement. Bone marrow examination was suggestive of a relapse. Fine needle aspiration of the parotid gland showed presence of myeloblasts. Patient was given FLAG-IDA chemotherapy, with which the parotid swellings rapidly regressed and she achieved a remission and was planned for allogenic bone marrow transplantation. Acute myelomonocytic and monoblastic leukemias are known to be associated with tissue infiltration. However, exocrine gland involvement such as parotid enlargement is rare and is associated with a poor prognosis as was seen in our patient who despite having inversion 16 positivity had poor disease outcome. Keywords: acute myeloid leukemia; parotid gland enlargement; granulocytic sarcoma.

Pyoderma gangrenosum and cobalamin deficiency in systemic lupus erythematosus: a rare but non fortuitous association

BackgroundPyoderma gangrenosum (PG) is an uncommon, idiopathic, ulcerative neutrophilic dermatosis. In many cases, PG is associated with a wide variety of different disorders but SLE in association with PG is relatively uncommon. In this article we present the case of a middle aged patient with PG as the initial clinical presentation of SLE. We also provide a brief review of cobalamin deficiency which occurred in our patient and evidence-based management options.Case presentationA 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud’s phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.ConclusionsWe report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.

PREVALENCE OF ORAL LESIONS AFTER RENAL TRANSPLANTATION: PROSPECTIVE STUDY

Objective: The objective of this study is to assess the prevalence of oral lesions in a cohort of renal transplant recipients before and just after transplantation. Study design: This is a cohort study involving 80 renal transplant recipients. The same researcher/dentist evaluated orofacial characteristics at the 3 different time points: immediately before transplantation, 15 to 20 days after transplantation, and 45 to 60 days after renal transplantation. Oral lesions were photographed and a presumptive diagnosis was established. Results: Immediately before transplantation, 3 of the 80 participants (3.7%) showed some oral soft tissue lesions. In the second and third time periods, 23.7% (18 out of 76) and 25.7% (19 out of 74) of the participants showed oral soft tissue lesions, respectively. Ulcers and candidiasis were the most frequent lesions associated with the use of everolimus (P = .023) and azathioprine (P = .034), respectively. Fewer patients reported xerostomia after transplantation than before (P < .001) and 8 renal transplant recipients presented with bilateral parotid gland enlargement in the third time period (P = .013). Conclusions: Orofacial lesions are common after renal transplantation in the short term and are particularly related to both toxicities of immunosuppressive drugs and immunosuppression. Apoio financeiro: São Paulo Research foundation (FAPESP) Objective: The objective of this study is to assess the prevalence of oral lesions in a cohort of renal transplant recipients before and just after transplantation. Study design: This is a cohort study involving 80 renal transplant recipients. The same researcher/dentist evaluated orofacial characteristics at the 3 different time points: immediately before transplantation, 15 to 20 days after transplantation, and 45 to 60 days after renal transplantation. Oral lesions were photographed and a presumptive diagnosis was established. Results: Immediately before transplantation, 3 of the 80 participants (3.7%) showed some oral soft tissue lesions. In the second and third time periods, 23.7% (18 out of 76) and 25.7% (19 out of 74) of the participants showed oral soft tissue lesions, respectively. Ulcers and candidiasis were the most frequent lesions associated with the use of everolimus (P = .023) and azathioprine (P = .034), respectively. Fewer patients reported xerostomia after transplantation than before (P < .001) and 8 renal transplant recipients presented with bilateral parotid gland enlargement in the third time period (P = .013). Conclusions: Orofacial lesions are common after renal transplantation in the short term and are particularly related to both toxicities of immunosuppressive drugs and immunosuppression. Apoio financeiro: São Paulo Research foundation (FAPESP)

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

Diagnosis of bilateral parotid enlargement (Sialosis) by sonography: A case report and literature review

Alcoholism is a common cause of sialosis. We describe a case of sialosiswith diffuse painless bilateral parotid gland enlargement associated with alcoholism. The diagnosis was based on clinical appearance, biochemical investigations and ultrasonography. The parotid swelling resulting from sialadenosisis asymptomatic, which concerns the patient because of cosmetic reasons. The dental practitioner needs to be able to differentiate sialosisfrom other pathological states that demonstrate bilateral parotid swelling to avoid unnecessary treatment.

Transient parotitis in the course of clozapine treatment: a case report and review of the literature

Introduction: Clozapine is an atypical antipsychotic, treatment of choice for patients unresponsive to, or intolerant of other antipsychotic drugs. While most of the adverse effects of clozapine are well discussed in the literature, clozapine-induced parotitis emerges as an uncommon complication, which clinicians should be aware of. Aim: The aim of this report is, by illustrating a case of clozapine-induced parotitis and reviewing the literature on the topic, to bring awareness of the occurrence of this potential adverse effect of clozapine treatment. Case Presentation: Due to poor response to several adequate trials with different antipsychotic medications a 57-year-old female with schizoaffective disorder was initiated on clozapine in 2008. The psychiatric condition of the patient notably improved in the following years. In 2016, after a decrease in her psychotropic therapy, the patient was hospitalized, and while restoring treatment with clozapine and divalproex she complained of increased salivation combined with painful bilateral parotid enlargement. The diagnosis of clozapine-induced parotitis was suggested. The medical condition had a favorable outcome within five days after administration of symptomatic medication. Conclusion: Adherence to drug treatment in psychiatric patients can be significantly improved if patients are well informed about the potential adverse effects of the administered medications and if the clinicians recognize and try to resolve them. Monitoring both common and rare adverse effects of clozapine treatment will give patients a chance of better therapy management.

How Are Ocular Signs and Symptoms of Dry Eye Associated With Depression in Women With and Without Sjögren Syndrome?

To determine whether ocular phenotypic features of keratoconjunctivitis sicca (KCS) and/or participant-reported symptoms of dry eye disease are associated with depression in women participants enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA). Cross-sectional study. Women enrolled in the SICCA registry from 9 international research sites. Participants met at least 1 of 5 inclusion criteria for registry enrollment (including complaints of dry eyes or dry mouth, a previous diagnosis of Sjögren syndrome (SS), abnormal serology (positive anti-Sjögren syndrome antigen A and/or B [anti-SSA and/or anti-SSB]), or elevated antinuclear antibody and rheumatoid factor), bilateral parotid gland enlargement, or multiple dental caries). At baseline, participants had oral, ocular, and rheumatologic examination; blood and saliva collection; and a labial salivary gland biopsy (LSGB). They also completed an interview and questionnaires including assessment of depression with the Patient Health Questionnaire 9 (PHQ-9). Univariate logistic regression was used to assess the association between depression and demographic characteristics, participant-reported health, phenotypic features of Sjögren syndrome, and participant-reported symptoms. Mixed-effects modeling was performed to determine if phenotypic features of KCS and/or participant-reported symptoms of dry eye disease were associated with depression, controlling for health, age, country or residence, and sex and allowing for nonindependence within geographic site. Dry eye complaints produced a 1.82-fold (95% confidence interval [CI] 1.38-2.40) higher odds of having depression compared to being symptom-free (P < .001). Additionally, complaints of specific ocular sensations were associated with a higher odds of depression including burning sensation (odds ratio 2.25, 95% CI 1.87-2.72, P < .001) compared to those without complaints. In both women with and without SS, the presence of symptoms of dry eyes and/or dry mouth rather than SS itself resulted in higher odds of depression. One particular ocular phenotypic feature of SS, a positive ocular staining score, was inversely correlated with depression. Participant-reported eye symptoms, particularly specific ocular sensations such as burning, were found to be positively associated with individual American College of Rheumatology/EUropean League Against Rheumatism (ACR/EULAR) SS criteria items.

EPIDEMIC PAROTITIS IN ARKANSAS

Epidemic parotitis or mumps is caused by a paramyxovirus well known for affecting the salivary glands and gonads. The signature feature of this disease is bilateral parotid enlargement. While subclinical infections occur, the classic presentation has become so rare that many experienced clinicians have never seen a case. The development of the MMR vaccine in 1971 along with a booster recommendation in the 1990s had essentially eliminated mumps in the U.S. More recently however, along with other communicable diseases, epidemic parotitis appears to be making a comeback; perhaps most publicized in the 2014 National Hockey League affair. Recent outbreaks in the nation’s heartland have affected schools in significant numbers, and Arkansas in particular has been hardest hit with 2802 reported cases as of February, 2017. Although all racial and socioeconomic groups have been impacted, Marshallese migrants living in Northwest Arkansas have been disproportionally affected, constituting 57% of all cases. While under vaccination initially was presumed to be the major reason behind the outbreak, it appears that the surge in cases is more driven by poverty and intense exposures afforded by crowded housing. We present a brief history of epidemic parotitis in Northwest Arkansas with emphasis on the unique Marshallese population.

Bilateral submandibular gland agenesis with bilateral parotid hypertrophy: a rare presentation

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Recurrent laryngeal nerve injury and hypoparathyroidism are two of the much discussed major complications Bilateral submandibular gland aplasia associated with bilateral hypertrophy of parotid gland is one of the rarest case presentation. The enlargement of parotid gland is mostly due to a compensatory mechanism of submandibular aplasia. This case report describes a 45 year female presented with diffuse swelling over bilateral preauricular and infraauricular area. CECT of face confirmed diffuse bilateral parotid gland enlargement associated with absence of submandibular gland.&lt;/span&gt;&lt;/p&gt;

Non –Invasive imaging modality in HIV-SGD

The HIV-infected population is increasing as major health hazard in both developing & developed countries. In the society, many of children are unaware of HIV or parents refuse to accept the HIV positive status due to social stigma, fear of discrimination & thus perpetuating the spread of HIV. Painless salivary gland swelling is one of the diagnostic & prognostic significance in HIV infected children out of which benign lympho-epithelial cyst is earliest manifestation with incidence of 30%. Here, we are highlighting a rare case report of bilateral parotid enlargement in young HIV infected patient.

Diffuse large B-cell lymphoma presenting as bilateral parotid enlargement, mimicking Sjögren's syndrome

Parotid gland lymphomas are rare with an incidence of 2% of all salivary gland tumors and are therefore commonly overlooked. They can occur de novo , arise in the background of a preexistent Sjogren's syndrome, or can be involved in disseminated non-Hodgkin's lymphoma (NHL). We report here a case of a 45-year-old female patient with disseminated NHL, presenting as bilateral parotid enlargement, clinically thought to be Sjogren's syndrome, diagnosed on fine needle aspiration cytology. A high index of suspicion and distinction from its more common mimics such as Sjogren's syndrome is needed to provide a quick and correct diagnosis as well as appropriate management.

Oro-facial lesions in human immunodeficiency virus infected children in Ile-Ife, Nigeria

The aim of this cross-sectional study was to determine the prevalence and types of oro-facial lesions and their relationship with the degree of immune suppression in human immunodeficiency virus (HIV)-infected children. This was compared with the prevalence among healthy HIV-negative children. The study was carried out in a tertiary institution in Southwestern Nigeria from May 2005 to March 2006. None of the children in the study had ever been treated with antiretroviral drugs. Thirty-four (87.2%) of 39 HIV infected children and two (9.5%) of the 21 HIV-uninfected children had oro-facial lesions (Fisher's exact, P = 0.0001). In the HIV-infected children, lymphadenopathy was the commonest lesion (82.1%) followed by oral candidiasis (43.6%), gingivitis (25.6%) and bilateral parotid enlargement (25.6%). The most common form of candidiasis was pseudomembranous. All the oro-facial lesions were more common in children with severe immune suppression and were not related to the age, gender or socioeconomic class of the children. It is therefore concluded that there is a high prevalence of oro-facial lesions in HIV-infected children in this study particularly in those with severe immune suppression. These lesions could serve as surrogate markers of HIV infection and aid in initiating prompt diagnosis where routine laboratory investigation for all children at risk is economically not feasible.

Brief Report: Ultrasonographic Assessment of Salivary Gland Response to Rituximab in Primary Sjögren's Syndrome.

To evaluate changes in salivary gland echostructure and vascularization after rituximab treatment in patients with primary Sjögren's syndrome (SS). Twenty-eight patients with primary SS included in the multicenter, randomized, double-blind, placebo-controlled Tolerance and Efficacy of Rituximab in Primary Sjögren's Syndrome (TEARS) trial underwent salivary gland ultrasonography before the first placebo or rituximab infusion and then 6 months later. Trial inclusion criteria were scores of ≥50 mm on at least 2 of 4 visual analog scales (VAS) evaluating dryness, pain, fatigue, and global disease; and recent-onset (<10 years) biologically active primary SS and/or systemic primary SS. Patients were randomly assigned (1:1) to rituximab (1 gm at weeks 0 and 2) or placebo. Ultrasonography of both parotid and submandibular glands was performed to assess echostructure (using a semiquantitative score of 0-4, with improvement defined as a ≥1-point decrease), size of each gland, and vascularization based on the resistive index of the transverse facial artery of the parotid gland before and after lemon juice stimulation. Of the 28 patients, 5 (18%; 3 in the placebo group and 2 in the rituximab group) had clinically detectable bilateral parotid gland enlargement at baseline. Parotid parenchyma echostructure improved in 50% of the rituximab-treated patients versus 7% of the placebo-treated patients (P = 0.03). In the submandibular glands, echostructure also improved in a larger proportion of rituximab-treated patients, although the difference was not significant (36% versus 7% of placebo-treated patients; P = 0.16). Gland sizes and resistive index remained unchanged. Ultrasonography showed improved salivary gland echostructure in patients with primary SS receiving rituximab, with no changes in salivary gland size or vascularization, 6 months after the first infusion.