An Unusual Case Report Of Unilateral Parotid Gland Sarcoidosis With Spontaneous Remission
Diamantopoulos, P. T., Charakopoulos, E., Viniou, N. A., Diamantopoulou, L., & Gaggadi, M. (2019). An unusual case report of unilateral parotid gland sarcoidosis with spontaneous remission. Medicine, 98(49), e18172. https://doi.org/10.1097/MD.0000000000018172
View Original Source →Abstract
RATIONALE: Parotid gland sarcoidosis is a well-recognized, but uncommon disease entity. Parotidectomy is most commonly performed to establish the diagnosis and most patients are treated with corticosteroids. PATIENT CONCERNS: A young female patient presented with right parotid enlargement and developed symptoms of facial nerve palsy during diagnostic investigation. DIAGNOSES: A fine-needle aspiration cytology showed granulomatous inflammation. The diagnosis of sarcoidosis was eventually established based on the demonstration of the characteristic lambda and panda signs by a Gallium-67 scintigraphy. INTERVENTIONS: No specific pharmacologic therapy was initiated. OUTCOMES: The patient's symptoms regressed completely over a period of 3 months. Additionally, she remains asymptomatic 2 years later. LESSONS: This case underlines the importance of not initiating corticosteroids in all patients with parotid gland sarcoidosis and suggests that parotidectomy can be avoided in the presence of characteristic for sarcoidosis imaging findings.
Case Details
Disease Location
Lymph nodes, parotid gland
Personal Characteristics
28-year-old woman. History of hypothyroidism and b-thalassemia heterozygosity.
Clinical Characteristics
Presented with right parotid enlargement. The patient had been diagnosed with left trigeminal neuralgia (tn) 10 weeks earlier. Treatment with pregabalin and a single dose of betamethasone induced successful recession of the symptoms. Fifteen days before presentation, the patient developed enlargement of the right parotid gland and ipsilateral submandibular area, which was accompanied by a diffuse headache of constant intensity without neurologic symptoms. Clinical examination revealed a 2-cm large, hard, round, irregularly demarcated, painless, and nonmobile mass in the right parotid region. A regional ultrasonography demonstrated an enlarged right parotid gland of a lobed margin and inhomogeneous echotexture. MRI scan showed diffuse inhomogeneous enlargement of both the superficial and deep parotid lobes and confirmed the presence of submandibular lymphadenopathy. Fine-needle aspiration (fna) cytology revealed a granulomatous parotitis and lymphadenitis. A week later, signs of right facial palsy with concomitant increase in the parotid’s size became apparent. Additionally, persistent frontal headache, low-grade fever, malaise, lower limb arthralgias, and an annular rash in the right knee and gluteal region were added. The diagnosis of sarcoidosis was established
Remission Characteristics
Over a period of 3 months, lymph node and parotid enlargement regressed completely, the rash resolved, and the patient was free of headache, fever, and symptoms of facial palsy
Treatment & Mechanisms
Clinical Treatment
Pregabalin and a single dose of betamethasone, biopsy
Non-Clinical Treatment
None reported