SARCOIDOSIS – SALIVARY GLAND INVOLVEMENT AS AN UNCOMMON PRESENTATION FORM CASE REPORT Diana Fernandes, Clara Brito, Pedro Soares, Luisa Teixeira, Sheila Arroja, Renato Saraiva Hospital Santo André, E.P.E. – Leira, Portugal Introduction Sarcoidosis is a multisystem disease, of unknown etiology, char- acterized by the presence of noncaseating granulomas in the in- volved organs. Lungs are affected in 90% of the cases. When di- agnosed, 30% of patients are asymptomatic, with incidental abnor- malities found on chest radiographs. Extrapulmonary involvement is more prevalent at skin, eyes, reticuloendothelial and muscular sys- tems. Kidney, heart, exocrine glands and central nervous system may also be affected. Objectives This work pretends to describe an uncomon presentation form of sarcoidosis, based on a case report. Materials & Methods Clinical file consult and extensive literature review on Medline con- cerning sarcoidosis Results The authors report the case of a 26-year-old female patient, with a history of hypertension, rhinosinusitis and obesity who presented with a 8-week bilateral salivary gland painless and firm enlargement. Symptoms: ● xerostomia ● exercise intolerance and fatigue ● absent dyspnea or cough complaints Physical examination: ● skin integrity ● normal pulmonary auscultation Laboratory study: ● erythrocyte sedimentation rate and ACE levels elevated ● normal red and white blood cell count ● kidney function preserved ● negative immunological study Salivary gland biopsy revealed noncaseating granulomas. Salivary gland biopsy Bilateral hilar adenopathy were identified in the patient’s chest ra- diograph and thoracic CT-scan. At the moment gallium scan results are on hold. Conclusions The reported clinical features, the elevation of ACE and the pres- ence of noncaseating granulomas on the salivary gland biopsy are compatible with sarcoidosis with salivary gland involvement as ini- tial presentation. At the moment the patient maintains exercise intolerance and fa- tigue complains with spontaneous resolution of the salivary glands enlargment. Therefore, the introduction of corticotherapy is still on hold. References ● Joseph P. Lynch, et al, Pulmonary Sarcoidosis,Semin Respir Crit Care Med. 2007;28(1):53-74 ● Baughman RP, Lower EE, du Bois RM. Sarcoidosis. Lancet 2003; 361:1111 ● Thomas KW, Hunninghake GW. Sarcoidosis. JAMA 2003; 289:3300 ● Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997; 336:1224 ● Talmadge E King, Jr, MD, Clinical manifestations and diagnosis of sarcoidosis, UpToDate, 2011
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SARCOIDOSIS – SALIVARY GLAND INVOLVEMENT AS AN UNCOMMONPRESENTATION FORM
CASE REPORTDiana Fernandes, Clara Brito, Pedro Soares, Luisa Teixeira, Sheila Arroja, Renato Saraiva
Hospital Santo André, E.P.E. – Leira, Portugal
IntroductionSarcoidosis is a multisystem disease, of unknown etiology, char-acterized by the presence of noncaseating granulomas in the in-volved organs. Lungs are affected in 90% of the cases. When di-agnosed, 30% of patients are asymptomatic, with incidental abnor-malities found on chest radiographs. Extrapulmonary involvement ismore prevalent at skin, eyes, reticuloendothelial and muscular sys-tems. Kidney, heart, exocrine glands and central nervous systemmay also be affected.
ObjectivesThis work pretends to describe an uncomon presentation form ofsarcoidosis, based on a case report.
Materials & MethodsClinical file consult and extensive literature review on Medline con-cerning sarcoidosis
ResultsThe authors report the case of a 26-year-old female patient, witha history of hypertension, rhinosinusitis and obesity who presentedwith a 8-week bilateral salivary gland painless and firm enlargement.
Symptoms:
● xerostomia● exercise intolerance and fatigue ● absent dyspnea or cough complaints
Physical examination:
● skin integrity● normal pulmonary auscultation
Laboratory study:
● erythrocyte sedimentation rate and ACE levels elevated● normal red and white blood cell count● kidney function preserved ● negative immunological study
Salivary gland biopsy revealed noncaseating granulomas.
Salivary gland biopsy
Bilateral hilar adenopathy were identified in the patient’s chest ra-diograph and thoracic CT-scan.
At the moment gallium scan results are on hold.
ConclusionsThe reported clinical features, the elevation of ACE and the pres-ence of noncaseating granulomas on the salivary gland biopsy arecompatible with sarcoidosis with salivary gland involvement as ini-tial presentation.
At the moment the patient maintains exercise intolerance and fa-tigue complains with spontaneous resolution of the salivary glandsenlargment. Therefore, the introduction of corticotherapy is still onhold.
References● Joseph P. Lynch, et al, Pulmonary Sarcoidosis,Semin Respir
Crit Care Med. 2007;28(1):53-74● Baughman RP, Lower EE, du Bois RM. Sarcoidosis. Lancet
2003; 361:1111● Thomas KW, Hunninghake GW. Sarcoidosis. JAMA 2003;
289:3300● Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med
1997; 336:1224● Talmadge E King, Jr, MD, Clinical manifestations and diagnosis
of sarcoidosis, UpToDate, 2011
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