Parotid gland swelling in Sjögren syndrome
• Presents at any time
• Often painful
• Unilateral or bilateral
• Intermittent or persistent
|Acute||Chronic (> 3 months)|
|Inflammatory sialadenitis||Inflammatory sialadenitis|
|Sialostenosis (fibrosis of ducts)||Sialostenosis|
|Bacterial sialadenitis||Bacterial sialadenitis|
|TIPS: SIALOLITHIASIS vs SIALOSTENOSIS|
|• Both cause pain and/or swelling after eating|
|• CT is useful for sialolithiasis, less so for sialostenosis|
|• Sialolithiasis may cause a sensation of sand or gravel in the mouth|
|• Sialostenosis may leave a sour taste or mucus in the mouth|
|• Both can be treated with secretagogues to stimulate flow or saliva or by milking (compressing the gland at first sign of pain or swelling). Stones often just pass, but may need to be removed surgically.|
• Apply pressure to major salivary gland (or have patient do so). If fluid comes out cloudy or purulent, think infection.
• Usually S. aureus
• Order imaging study to rule out obstruction
• Treatment: Amoxicillin(Drug information on amoxicillin)-clavulanate 875 mg bid for 2-4 weeks
Strong association with Sjögren syndrome (6.6 x relative risk, affects up to 5% of patients within 10 years of disease onset.
Typically presents as salivary gland swelling or adenopathy.
Treat aggressively. Tends to recur and mortality rate is high (23-33%, accounting for 20% of deaths among Sjögren patients).
• Glandular swelling
• Palpable purpura at initial presentation
• Mixed monoclonal cryoglobulinemia
• Low C4