Multilocular Thymic Cyst in a Patient with Diffuse Infiltrative Lymphocytosis Syndrome

Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a multisystem disorder characterised by bilateral salivary gland enlargement and/or xerostomia in patients with Human Immunodeficiency Virus (HIV) infection. A 16 year old young male patient, presented with bilateral painless parotid swelling for five years. On evaluation, he was found to have oral thrush and bilateral cervical lymphadenopathy. He turned out to be positive for HIV with a cluster of differentiation 4 (CD4) count of 237/mcl. On Positron Emission Tomography- Contrast Tomography (PET-CT), a multiloculated thymic cyst (13×9×6 cm) was noted. He was diagnosed to have DILS with a large multiloculated thymic cyst. The patient was managed with tenofovir, lamivudine and efavirenz along with cotrimoxazole prophylaxis and fluconazole and was followed uptil nine months for the regress of the conditions. The case highlights the rare association between DILS and thymic cyst.

Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome?

Objective Persistent (≥2 months) major salivary gland enlargement in primary SS (pSS) patients is a well-known sign of possible involvement by B cell lymphoma. The study aimed to evaluate the diagnostic accuracy and safety of US-guided core needle biopsy (CNB) of major salivary glands compared with open surgical biopsy. Methods Prospective pSS patients (cases) with clinically persistent salivary gland enlargement underwent US-guided CNB and were compared with retrospective pSS patients (controls) submitted to open surgical biopsy. The features analysed were pre-biopsy clinical and laboratory findings, adequacy of the material for histology and diagnostic-rendered and biopsy-related complications (reported by the patient with a questionnaire and clinically verified). Results Thirteen cases underwent US-guided CNB: in nine, biopsy was performed on the parotid gland and in four it was performed on the submandibular gland. Sufficient material was obtained for pathological diagnosis in all samples. The final diagnoses were 5 (38.5%) B cell lymphoma, 1 (7.7%) lymphoepithelial sialadenitis, 4 (30.7%) other sialadenitis (granulomatous consistent with sarcoidosis, IgG4-related disease, chronic sclerosing, diffuse chronic) and 3/13 (23.1%) miscellaneous lesions. Thirteen controls underwent open surgical biopsy of the parotid. In one, inadequate material was obtained, while in 12 (92.3%) the pathologic diagnoses were 4 (33.3%) B cell lymphoma, 2 (16.7%) lymphoepithelial sialadenitis, 4 (33.3%) uncertain lymphoproliferative lesions and 2 (16.7%) miscellaneous lesions. Six cases (46.1%) reported six transient complications and 12/13 (92.3%) controls had 2 persistent and 14 transient complications. Conclusion US-guided CNB represents a novel, clinically relevant and safe approach for the management of pSS patients with parotid or submandibular persistent enlargement.

Medication Associated Salivary Gland Alterations– Assessment of risk

Brief Background Medication Associated Salivary Gland Alterations (MASGA) are a common set of adverse events (AE) associated with many common medications. There are a few reports of the risk of MASGA with medication. Materials and Methods Using whole database approach, the Food and Drug Administration Adverse Event Reporting System (FAERS) of the United States of America was searched for MASGA. Common alterations and drugs associated were assessed for the Reporting Odds Ratio, as mentioned in pharmacovigilance researches. Results In the time phase considered, there were in all 16996785 AE reported in the FAERs database. Of this 68624 were related to MASGA with Dry Mouth and hypersecretion being most common. Anti-psychotic drugs predominated the hypersecretion spectrum with clozapine having a ROR of 58.04 followed by Haloperidol (25.29). Among the drugs that caused SG enlargement, potassium iodide (1335.32) and Oxyphenbutazone (696.58) had the highest ROR. Non-specific description of altered saliva was seen with high ROR in haloperidol and enoxaparin sodium (14.22). Summary and Conclusions Odds Ratio of drugs causing MASGA are. chronic medication such as those given for non-communicable, life style diseases and psychiatric medications known to cause MASGA. Key Words Salivary Alterations, Xerostomia, Salivary gland enlargement, Adverse Events, Pharmacovigilance