Parotid Gland Enlargement Research Articles

AB0887 Autologous Stem-Cell Transplantation (ASCT) as Treatment Option in A Child with Severe Systemic Sclerosis

BackgroundClinical presentation of systemic sclerosis in overlap syndrome with severe skin involvement can be very severe while standard treatment could be ineffective with necessity to apply autologous stem-cell transplantation (ASCT).ObjectivesAfter...

THU0396 Igg4-Related Disease or Primary Sjogren Syndrome? Organ-Specific Involvement and Immunological Profile Are Clues in Differentiating Two Diseases with A Common Clinical Presentation

BackgroundIgG4-related disease and primary Sjögren syndrome (SS) share clinical presentations (sicca features, enlarged exocrine glands) and systemic organ involvement, with histopathological demonstration of IgG4+ infiltrative cells being the key differential...

SP0098 Etiology of SICCA Syndrome: the Forgotten Causes

A 54-year old man was referred in 2010 to our outpatient clinic with a 4-year history of dry mouth and eyes and diffuse arthralgias. Review of symptoms was essentially negative....

Index of Suspicion

The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr. Deepak Kamat at DKamat@med.wayne.edu. An 18-year-old male with a 3-year history of alcohol abuse is referred from a rehabilitation center for fever, nausea, and nonbloody diarrhea for 3 days. Six weeks ago, he enrolled in an alcohol rehabilitation program and stopped drinking alcohol. Three weeks later, he noticed yellowing of his eyes and skin, difficulty sleeping, and dyspnea. On examination, his temperature is 100.6°F (38.1°C), blood pressure is 99/62 mm Hg, pulse is 124 beats per minute, and respiratory rate is 24 breaths per minute. He is slow to answer questions. There is no asterixis. He appears thin and jaundiced with enlarged parotid glands. Decreased breath sounds are noted on the right. A tender, enlarged liver and mild abdominal distension are noted. Trace bilateral lower-extremity edema is present. No stigmata of chronic liver disease are found. Laboratory findings reveal the following: white blood cell count, 25,600/μL (25.6 × 109/L) (87% neutrophils); hemoglobin, 8.2 g/dL (82 g/L); mean corpuscular volume, 106 fL; platelets, 40 × 103/μL (40 × 109/L); sodium, 135 mEq/L (135 mmol/L); potassium, 3.5 mEq/L (3.5 mmol/L); chloride, 106 mEq/L (106 mmol/L); bicarbonate, 15 mEq/L (15 mmol/L); blood urea nitrogen, 24 mg/dL (8.6 mmol/L); creatinine, 1.01 mg/dL (89 μmol/L); glucose, 118 mg/dL (6.6 mmol/L); alkaline phosphatase, 182 U/L; aspartate aminotransferase (AST), 194 U/L; alanine aminotransferase (ALT), 71 U/L; total bilirubin, 11.8 mg/dL (201.8 μmol/L); direct bilirubin, 7.3 mg/dL (124.9 μmol/L); albumin, 2.7 g/dL (27 g/L); prothrombin time, 19.2 seconds; and international normalized ratio, 1.4. Ethanol and acetaminophen were not detected in the serum. A chest radiograph reveals a right pleural effusion …

Disseminated non-Hodgkin′s lymphoma presenting as unilateral parotid gland enlargement with facial nerve palsy

The head and neck is the most common area for the presentation of lymphoproliferative disorders. Primary involvement of salivary glands is uncommon. Non-Hodgkin's lymphoma constitutes a group of malignancies those arises from cellular components of lymphoid or extra nodal tissues. Here we report a case of a 70-year-old male patient who presented with left parotid gland enlargement with left facial nerve palsy and involvement of other nodal sites, which is rarely reported in the literature.

Acute sialadenitis of parotid gland: Anaesthesia mumps

Acute sialadenitis of parotid gland: Anaesthesia mumps

PReS-FINAL-2276: IgG4 related disease in a 10-year-old girl

A 10-year-old girl developed an enlargement of parotid and submandibular salivary glands and lymph nodes up to 2.5 cm associated with edema of her upper eyelids. In further follow-up, she developed non-palpable, vasculitic skin lesions. She received cephixime, that co-incided with partial regression of lymph nodes. Re-occurrence of vasculitic lesions with bilateral edema of upper eyelids resembling Miculitz disease was observed. At 7 years of age, she developed asthma requiring the use of bronchodilators. Clinical examination: a 10-year-old girl, pale skin, at the both calves irregularly shaped, livid, painless, vasculitic lesions, 2-3 cm in size. The upper eyelids are swollen. Parotid and submandibular salivary glands and submandibular lymph nodes are enlarged.

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Introduction: Introduction End organ dysfunction related to infective endocarditis (IE) is a common cause for the referral to the intensive care unit. A thorough history and physical examination remains an integral part of management of patients with IE. Intensivists should maintain a high index of suspicion towards detecting rare manifestations of IE. We present a case of Methicillin sensitive Staphylococcus aureus (MSSA) endocarditis with two such rare complications in the form of bilateral endophthalmitis and parotitis which were diagnosed early and treated promptly. Case presentation A 63 year old male with a past history of mitral valve annuloplasty was hospitalized for fever with rigors of four day duration. His admission vitals were notable for fever (103 F), tachycardia and tachypnea. Physical examination revealed an apical holosystolic murmur and painful erythematous finger nodules (Osler's nodes).Pertinent positive labs included thrombocytopenia (count of 40,000), elevated BUN (60) and creatinine (1.7). Appropriate antibiotics were initiated for concern of IE; blood cultures grew Methicillin sensitive Staphylococcus aureus (MSSA) and subsequent work up with Trans-esophageal echocardiography showed mitral valve vegetation's (> 2 cm) on the anterior leaflet of the mitral valve with concomitant severe mitral regurgitation. Hospital course was complicated by the development of sudden painful bilateral parotid gland enlargement, bilateral decreased visual acuity and confusion. A thorough visual, neck and neurological exam revealed findings of bilateral endophthalmitis which was emergently treated with vitreous aspiration and intravitreal antibiotic instillation leading to an improvement in vision. Vitreal fluid cultures were positive for MSSA. Bilateral Parotid gland enlargement- acute parotitis secondary to disseminated sepsis was successfully treated with antibiotics and hydration. MRI of brain revealed multiple small cerebral infarcts and small areas of intracerebral hemorrhage consistent with septic infarcts and secondary hemorrhagic conversion. While the risks and benefits of emergent mitral valve replacement surgery were being contemplated, unfortunately only four days into the hospital course patient suffered a massive intracerebral hemorrhage and passed away. Discussion The pathogenesis for complications in IE includes embolic, local spread of infection, metastatic infection or immune-mediated damage. Embolization remains a distressingly common complication of IE and can occur even after appropriate therapy. Endogenous endophthalmitis is a rare complication of infective endocarditis that occurs due to direct invasion of ocular tissues (septic emboli) or by changes in vascular endothelium caused by substrates released during infection. The most common cause of the infection is Staphylococcus aureus. Endogenous endophthalmitis due to MSSA infective endocarditis is an extremely rare complication. Intravitreal and systemic antibiotic therapy should be initiated promptly. Acute bilateral parotitis is rare and is associated with mumps and connective tissue disorders; while in our case it seems to be secondary to MSSA bacteremia and septic emboli. Bilateral Endophthalmitis and Parotitis are very rare complications of infective endocarditis with only a few case reports published to date. Our patient is the first case in literature where both manifestations occurred together as a part of embolic phenomenon. Most common pathogen implicated in the setting of endocarditis is Staphylococcus aureus. Conclusion: Infective endocarditis (IE) is associated with a myriad of complications. It is important to recognize rare complications of IE like bilateral endophthalmitis and parotitis and act rapidly to prevent morbidity associated with it.

Does tocilizumab contribute to elevation of rheumatoid factor and induction of paradoxical syaloadenitis in rheumatoid arthritis patients?

A 56-year-old woman, treated with tocilizumab (TCZ) for 8months for severe rheumatoid arthritis (RA), was admitted to the hospital due to the swelling and tenderness of parotid glands. The patient was diagnosed with seropositive erosive RA in 1988, and treated with different disease modifying antirheumatic drugs (DMARDs) that were used together with a low dosage of glucocorticoides, followed by biologic therapy with infliximab and adalimumab which also proved to be inefficient. The patient had an excellent initial response on TCZ therapy. After 8months, she was presented with an extreme enlargement of parotid glands. Bacterial, viral, and granulomatous diseases were excluded. A spectrum of autoantibodies including anti-Ro and anti-La showed normal values, expect for slightly elevated anti-cyclic citrullinated peptide (anti-CCP) and extreme elevation of the rheumatoid factor (RF) to 10,100IU/ml. The biopsy of salivary glands was done and histological specimen showed limphoplasmocytic syaloadenitis. Tocilizumab therapy was stopped and the dosage of glucocorticoids and methotrexate (MTX) was raised. After 6weeks, the patient was in better condition with slightly lower levels of RF (9,010IU/ml). We hypothesise that in this patient, TCZ stimulated RF hyper production which can induce a paradoxical secondary syaloadenitis in RA.

Bilateral Parotid Swelling With Blindness

We report a case of a 32-year-old woman who presented with bilateral parotid gland enlargement. She had no systemic symptoms such as fever, cough, and weight loss. She had bilateral blindness for a long time. The results of a physical examination revealed a bilateral firm, painless mass in the parotid region. A computed tomographic scan showed no clear lymphadenopathy in the neck but showed localized infiltrates and multiple pulmonary nodules with enlargement of the mediastinal and axillary lymph nodes in the chest. The patient underwent a superficial parotidectomy. A histopathologic finding revealed an epithelioid noncaseating granuloma, which is consistent with sarcoidosis. In summary, this current study shows that sarcoidosis should be considered in the differential diagnosis of all painless swelling of the parotid gland, especially in women, which could be an earlier complaint.

The Heerfordt-Waldenström Syndrome as an Initial Presentation of Sarcoidosis

Sarcoidosis is a granulomatous disease of unclear etiology, which commonly presents with cough, dyspnea, chest pain, fever, weight loss, arthralgias, and erythema nodosum. Heerfordt-Waldenström syndrome, a rare presentation of sarcoidosis, is characterized by the presence of parotid gland enlargement, facial palsy, anterior uveitis, and fever. Here we present a case of a 59-year-old nonsmoking African American woman who presented with 3 days of progressively worsening left facial droop, difficulty swallowing, and blurred vision. Over the prior 4 months, she had had a productive cough, fevers, night sweats, and an unintentional 30-pound weight loss. Physical examination revealed a left facial droop involving the forehead, cheek, and chin with an inability to close the left eyelid. Her serum angiotensin-converting enzyme level was twice the upper limit of normal. Prominent hilar markings were identified on chest x-ray, but no focal opacity was seen. Fine-needle aspiration of a preauricular lymph node revealed noncaseating granulomas consistent with granulomatous lymphangitis. The patient was given a diagnosis of Heerfordt-Waldenström syndrome, or uveoparotid fever. Treatment with a high-dose steroid improved her parotid gland enlargement, facial palsy, and anterior uveitis.

Concomitant lymphocyte-rich classical Hodgkin's lymphoma and Warthin's tumor

Lymphomas associated with Warthin's tumor (WT) are extremely rare. Here, we report the simultaneous occurrence of lymphocyte-rich classical Hodgkin's lymphoma (LRCHL) and WT in a 78-year-old patient whose symptoms included an enlargement of the left parotid gland. Upon parotidectomy, the tissue specimen showed a WT with extensive replacement of the lymphoid stroma by small lymphocytes and some scattered Reed-Sternberg cells; however, the oncocytic epithelium was preserved. Further investigation revealed mediastinal and abdominal lymphadenopathy, consistent with stage IVB disease. To our knowledge, this is the first case report of LRCHL associated with WT. The lymphoid stroma in WT is part of the systemic lymphoid tissue and thus may be involved in the dissemination of the lymphoma. This case serves as a reminder that a careful evaluation of the histomorphological and immunohistological features of the lymphoid tissue is required for a WT biopsy.

AB0429 Clinical manifestations and their association with the immunological profile of primary sjögren’s syndrome

Objectives1-Describe the frequency of the clinical manifestations. 2- Assess their association with the antibodies anti Ro/La, ANA, Rheumatoid Factor (RF) in patients with Primary Sjögren’s Syndrome (pSS).MethodsIt was analyzed the...

Clinical features distinguishing lymphoma development in primary Sjögren's syndrome—A retrospective cohort study

ObjectiveThe objective is to determine the relationship between clinical features and non-Hodgkin lymphoma (NHL) development in primary Sjögren's Syndrome (pSS), taking recently designed disease activity/severity scores into account. MethodsMedical charts of pSS patients were retrospectively analyzed, scoring first and last visits with the (cumulative) EULAR Sjögren's Syndrome Disease Activity Index and counting extraglandular manifestations, comparing patients with and without NHL. ResultsOne hundred ninety-five patients were analyzed with a median follow-up of 92 months (range 12–256). Twenty-one patients (11%) had NHL. Associations of parotid gland enlargement (OR 2.84) and low C4 (OR 7.71) with NHL were confirmed. In NHL patients, development of purpura, peripheral neuropathy (PNP), and glomerulonephritis (GN) concurred with lymphoma in 3/3, 5/7, and 2/2 of cases, respectively. Otherwise, purpura and PNP were not associated with NHL later on. This suggests that these symptoms might represent paraneoplastic events (in 16%, 24%, and 100% of our cases, respectively). Presence of IgM-kappa clonal components was associated with lymphoma in 64% of cases. Disease activity/severity scores at first visit could not predict lymphoma development, nor was the pSS disease course significantly worse in patients with NHL. ConclusionsIn our cohort, no clinical manifestation or disease score could clearly select patients with subsequent lymphoma development. Presence of IgM-kappa clonal components and development of purpura, PNP, and GN should alert the clinician for the presence of lymphoma.

Fatal Blastoid Variant Mantle Cell Lymphoma in a Patient with Sjögren's Syndrome

Primary Sjögren's syndrome (pSS) is an autoimmune disorder of the exocrine glands presenting with progressive ocular and oral dryness, parotid gland enlargement, and often with extraglandular manifestations. In this group of patients the risk of development of non-Hodgkin's lymphoma is 16-fold compared to healthy population, mainly of the MALT lymphoma type. This case reports a 52-year-old woman with pSS developing a progressively growing mass at face and neck compatible with blastoid variant mantle cell lymphoma and a fatal outcome.

Oral lesions and immune status of HIV infected adults from eastern Nepal

Objective: To document the prevalence, age and gender distribution of oral lesions in HIV infected adults and the influence of highly active antiretroviral therapy and correlate them to the immune status of the patients. Materials and Methods: Oral lesions were diagnosed by a detailed physical examination by trained and calibrated examiners according to the case definitions established by the Oral HIV/AIDS research alliance. Demographic details, risk behavior patterns and oral symptoms and habits were collected by a questionnaire. Results: 81 patients; 54 men and 27 women aged between 20 – 55 years participated in the study. A total of 49 patients; 60.5% had some oral lesion when examined. Oral candidiasis (21 %) and oral melanosis (21%) were the most common lesions, followed by linear gingival erythema, oral hairy leukoplakia, necrotizing ulcerative periodontitis/gingivitis, herpes labialis, parotid gland enlargement and reccurent apthous ulcers. Oral hairy leukoplakia was exclusively seen in men (p=0.018). All six cases of herpes simplex lesion were seen in non - anti retro viral group (p=0.073) while oral candidiasis was commonly noted in the anti retro viral group (p=0.073). Lowering CD4 counts had the strongest association with the prevalence of oral candidasis (p=0.012), pseudomembranous candidiasis (p=0.014) and oral hairy leukoplakia (p= 0.065). Conclusion: This study shows a high prevalence of oral candidiasis, melanosis, linear gingival erythema and oral hairy leukoplakia in the patients. Key words:HIV, AIDS, oral lesions, prevalence.

Bilateral parotitis as the initial presentation of childhood sarcoidosis

The differential diagnosis of bilateral parotid gland enlargement in children includes infectious, inflammatory, and neoplastic disorders. We present the case of a 13-year-old male who presented with a 5-week history of bilateral parotid swelling. On exam, both parotid glands were nontender, smooth, and diffusely enlarged. He had slightly elevated inflammatory markers, but other lab results were normal. A neck CT revealed symmetric enlargement of the parotid, submandibular, and sublingual glands. A chest CT revealed scattered peripheral pulmonary nodules and bilateral hilar adenopathy. A parotid gland biopsy showed multiple noncaseating granulomas with multinucleated giant cells surrounded by lymphocytes, consistent with the diagnosis of sarcoidosis. Special stains for acid-fast and fungal organisms were negative. Using this illustrative case, we discuss the differential diagnosis of bilateral salivary gland enlargement in children and review the etiology, diagnosis, clinical manifestations, and treatment of pediatric sarcoidosis.

Arterio-venous malformation of parotid gland hiding occult adenoid cystic carcinoma in an eight-year-old girl

We report an 8-year-old girl presenting with a parotid gland enlargement since her birth. All clinical and radiological findings indicate a vascular abnormality more likely an arteriovenous malformation. Partial parotidectomy was performed for cosmetic reasons by preserving all branches of facial nerve despite a very bloody operation. The pathology report indicated arteriovenous malformation surrounding adenoid cystic carcinoma with a diameter of 12 mm with intact surgical margins.

Polyneuropathy Associated with the Diffuse Infiltrative Lymphocytosis Syndrome

Diffuse infiltrative lymphocytosis syndrome (DILS) arises in HIV-positive patients secondary to infiltration of lymphocytes into the peripheral tissues and produces the disease's characteristic symptoms-parotid gland enlargement and a sicca syndrome. Many patients, however, first seek medical attention for treatment of the extraglandular manifestations of DILS, most commonly interstitial pneumonitis. In this case report, we describe an atypical presentation of DILS characterized by polyradiculoneuropathy in the absence of parotid gland enlargement or interstitial pneumonitis. Minor salivary gland biopsy of the patient's lip confirmed a chronic inflammatory state with lymphoid aggregates within the minor salivary glands. He was started on prednisone with immediate improvement in his symptoms. This report illustrates for clinicians the diverse extraglandular manifestations of DILS and underscores the importance of considering it in the differential diagnosis of HIV-positive patients with a preserved CD4 count who present with peripheral neuropathy.

Leiomyom

Leiomyomas are benign neoplasias consisting of smooth muscle tissue, with the most common localization being the uterus. Less often incidence is observed in other regions such as the blood vessels, esophagus and lower urinary tract. Leiomyomas occur only rarely in the head and neck area. We report about a female patient being treated because of progredient swelling and enlargement of the left parotid gland. The histological specimen revealed a regressive transformed tumor.