P3 Wegener's granulomatosis patient presenting with bilateral parotid gland swelling, submandibular gland swelling and sicca symptoms mimicking Sjogren syndrome

We present the case of a previously healthy 59-year-old man who was under treatment for scleritis and episcleritis when he developed a parotid-gland swelling and pus-producing sinus. On surgical exploration, the features were those of a parotid abscess, but the lesion not only failed to heal post-operatively but increased in size very significantly. There was also severe necrotizing keratitis of the eyes. Due to clinical suspicion and a positive antineutrophil cytoplasmic antibodies test, Wegener’s granulomatosis was diagnosed and the patient successfully treated with cyclophosphamide and steroids. Previously, a number of cases of Wegener’s granulomatosis causing salivary-gland swelling have been reported in the literature; this is the first case in which the disease has masqueraded as a parotid abscess.

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Parotid gland non-Hodgkin lymphoma in primary Sjögren syndrome

Rheumatology International ◽

10.1007/s00296-011-1851-9 ◽

2011 ◽

Vol 32 (5) ◽

pp. 1387-1390 ◽

Cited By ~ 5

Author(s):

Thierry Zenone

Keyword(s):

Parotid Gland ◽

Hodgkin Lymphoma ◽

Sjögren Syndrome ◽

Sjogren Syndrome ◽

Non Hodgkin Lymphoma ◽

Primary Sjögren Syndrome

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Salivary Gland Ultrasonography as a Diagnostic Tool for Secondary Sjögren Syndrome in Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.141149 ◽

2015 ◽

Vol 42 (7) ◽

pp. 1119-1122 ◽

Cited By ~ 5

Author(s):

Sunil Das ◽

DoQuyen Huynh ◽

Hong Yang ◽

Arnoldas Ceponis ◽

Arthur Kavanaugh

Keyword(s):

Rheumatoid Arthritis ◽

Salivary Gland ◽

Oral Health ◽

Disease Activity ◽

Diagnostic Tool ◽

Scoring System ◽

Sjögren Syndrome ◽

Sjogren Syndrome ◽

Sicca Symptoms

Objective.To assess salivary gland ultrasonography (US) as a diagnostic tool for secondary Sjögren syndrome (sSS) in patients with rheumatoid arthritis (RA).Methods.Salivary gland US images from 30 patients with RA were graded using a validated semiquantitative scoring system. Sicca symptoms, oral health, and RA disease activity were assessed.Results.US changes consistent with SS were found in 40% of patients. Patients with higher US scores had more sicca symptoms as well as higher RA activity and poorer oral health.Conclusion.Salivary gland US may aid the diagnosis of sSS in patients with RA.

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IS THERE AN EARLY ULTRASONOGRAPHIC PATTERN IN SALIVARY GLANDS IN BOTH PRIMARY AND SECONDARY SJÖGREN SYNDROME?

Romanian Journal of Rheumatology ◽

10.37897/rjr.2017.1.6 ◽

2017 ◽

Vol 26 (1) ◽

pp. 30-37

Author(s):

Vasilia Iorgoveanu ◽

◽

Violeta Bojinca ◽

Madalina Gheorghe ◽

Diana Mazilu ◽

...

Keyword(s):

Parotid Gland ◽

Salivary Glands ◽

Early Period ◽

Sjögren Syndrome ◽

Biological Data ◽

Inflammatory Disorder ◽

Sjogren Syndrome ◽

Parotid Glands ◽

Submandibular Glands ◽

Left And Right

Background. Sjögren syndrome (SS) is a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs. Ultrasonography (US) demonstrates specificity and sensibility in major salivary glands (SG) evaluation. Recent data confirm US might be used as primary evaluation technique for its ability to show structural alterations of parenchyma (1). Objective. To assess the gray scale (GS) parenchymal inhomogeneity of major SG in patients with established primary and secondary SS and correlate with clinical and biological data. Methods. Consecutive patients with SS were recruited and SG US was performed. Inhomogeneity of glandular parenchyma was quantified binary on each gland. ESSDAI and ESSPRI scores were calculated. Statistics was performed with SPSS. Results. Twenty one (42.85% primary SS, 90.47% female) consecutive patients were included. Mean age was 53.66+/-12.99 years and disease duration 5.33+/-3.74 years. Antibody SSA/SSB presence was found in 85.7% (18/21). ESSDAI mean was 8.67+/-8.9 (0-29), ESSPRI 10.13+/-5.59(0-20). There were no differences regarding ESSDAI and ESSPRI in the two groups (primary and secondary SS). Right parotid gland showed alterations in 71.4% patients (77% with primary SS, 66% with secondary SS). Frequently inhomogeneity was found in all major SG (33%, 22% left and right submandibular, 77%, 44.4% left and right parotid glands) in primary SS. Both submandibular glands were symmetrically involved (p<0.02). Duration of disease was negatively correlated to inhomogeneity of right parotid gland (p<0.02). Conclusion. Inhomogeneity in major SG in GS US was found in the majority of patients with primary and secondary SS. The symmetrical involvement of submandibular glands was significant. The inhomogeneity appears in the early period of diagnosis. No major differences were found between two groups.

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Autoantibodies against Submandibular Gland Muscarinic Cholinoceptor Subtypes in Primary Sjögren Syndrome

European Journal of Inflammation ◽

10.1177/1721727x0500300305 ◽

2005 ◽

Vol 3 (3) ◽

pp. 135-141 ◽

Cited By ~ 4

Author(s):

S. Reina ◽

L. Sterin-Borda ◽

B. Orman ◽

E. Borda

Keyword(s):

Submandibular Gland ◽

Binding Sites ◽

Rank Order ◽

Muscarinic Acetylcholine Receptor ◽

Sjögren Syndrome ◽

Sjogren Syndrome ◽

Primary Sjögren Syndrome ◽

Kd Values ◽

Number Of Binding Sites ◽

Chronic Autoimmune Disease

Sjögren Syndrome (SS) is a chronic autoimmune disease characterized by parasympathetic exocrine gland dysfunction. Here, the involvement of submandibular gland muscarinic acetylcholine receptor (mAChR) M4 subtype is proposed as an IgG target together with M1 and M3 mAChR subtypes. The Kd values were total membranes 0.20 ± 0.017 nM; acini membranes 0.33 ± 0.023 nM and duct membranes 0.22 ± 0.040 nM and Bmax values were total, 1038 ± 24, acini, 1359 ± 28 and ducts, 593 ± 30. The rank order of Bmax was: acini > total > ducts, indicating that acini express the highest number of binding sites. The specific mAChR antagonists (4-DAMP [M3], tropicamide [M4], pirenzepine [M1]) and the corresponding synthetic peptides impaired IgG-mAChR subtype interactions. The specificity of these reactions was assessed by the corresponding affinity-purified anti peptide antibodies recognizing M4, M3 and M1 mAChR. These data concerning autoantibodies contribute to explain the pathogenesis of SS and also represent a new clinical marker for SS diagnosis.

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Case report. A rare case of triple-hit diffuse large B-cell lymphoma of the parotid gland in a patient with Sjogren’s syndrome

Romanian Journal of Rhinology ◽

10.1515/rjr-2017-0011 ◽

2017 ◽

Vol 7 (26) ◽

pp. 103-107

Author(s):

Adelina Birceanu ◽

Anca Evsei ◽

Adrian Dumitru ◽

Maria Sajin ◽

Codrut Sarafoleanu

Keyword(s):

Salivary Gland ◽

Case Report ◽

Parotid Gland ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Sjögren Syndrome ◽

Low Grade ◽

Sjogren Syndrome ◽

Large B Cell

Abstract BACKGROUND. Primary malignant lymphomas of the salivary gland are rare, accounting for 2% of salivary gland tumors and 5% of all extranodal lymphomas. The clinical presentation is not particularly characteristic, a feature that usually leads to diagnostic and treatment delays. CASE REPORT. We report a case of a parotid gland triple-hit diffuse large B-cell (DLBCL) lymphoma associated with follicular lymphoma in a 76-year-old female patient with a unique personal history, which included a diagnosis of Sjogren Syndrome and exposure to a toxic working environment with pesticides. Diffuse large B-cell lymphomas are uncommon given the fact that most lymphoid malignancies are low-grade lymphomas, with MALT (mucosa associated lymphoid tissue) lymphomas being the most common. Triple-hit DLBCL are extremely rare and the diagnosis can be challenging. Parotidectomy, as the first step, must be followed by histopathology and immunohistochemistry for final diagnosis and treatment. CONCLUSION. This case highlights the fact that B-cell lymphoma in the salivary gland can be unrecognized due to unspecific symptoms and requires immunohistochemistry studies for confirmation. It is important to recognize triple-hit lymphoma due to its worse prognosis and differentiated treatment. Patients with Sjogren syndrome have additional risk factors for progression to lymphoma.

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