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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.
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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