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Case Reports
. 2007 Feb;27(1):41-4.

Bilateral multiple sialolithiasis of the parotid gland in a patient with Sjögren's syndrome

I Konstantinidis  1 , S Paschaloudi, S Triaridis, G Fyrmpas, S Sechlidis, J Constantinidis
Affiliations
Case Reports

Bilateral multiple sialolithiasis of the parotid gland in a patient with Sjögren's syndrome

I Konstantinidis et al. Acta Otorhinolaryngol Ital. 2007 Feb.

Abstract
in English, Italian

The presence of multiple calculi in the major salivary glands is an uncommon finding. Sjögren's syndrome is a chronic autoimmune disease characterized by lymphocyte-mediated destruction of the exocrine glands. The case is presented of a 49-year-old female with Sjogren's syndrome found to have bilateral multiple sialolithiasis in the parenchyma of the parotid glands. The patient presented with a right sided painful inflamed swelling of the parotid region. Even though she had been diagnosed with primary Sjögren's syndrome 3 years prior to admission, she did not report any previous episode of sialadenitis. Full blood count showed leukocytosis (white blood cells = 14,900/10(6) L) with neutrophilia (75%). Radiological assessment included ultrasound and computed tomography scan of the parotids which demonstrated intra-parenchymal multiple calculi of both parotid glands and obstruction of the right Stensen's duct. The patient was treated with intravenous antibiotics and anti-inflammatory drugs. On the second day of hospitalisation, she reported spontaneous extrusion of a calculus during massage of the gland, with immediate relief of symptoms. In patients with Sjögren's syndrome and radiological findings of calculi in the major salivary glands, close observation is mandatory for better control of recurrent sialadenitis and early recognition of mucosa-associated lymphoid tissue lymphomas.

La presenza di calcolosi multipla nelle ghiandole salivari maggiori non è frequente. La sindrome di Sjögren è un disordine autoimmune caratterizzato da distruzione cellulo-mediata delle ghiandole esocrine. Presentiamo il caso di una paziente di 49 anni con sindrome di Sjögren in cui si è osservata scialolitiasi bilaterale multipla delle ghiandole parotidi. La paziente si è presentata con gonfiore dolente della parotide destra. Nonostante la diagnosi di sindrome di Sjögren tre anni prima la paziente non aveva mai presentato episodi di scialoadenite. Gli esami di laboratorio hanno evidenziato una leucocitosi (14.500 WBC) con neutrofilia (75%) e le indagini radiologiche (esame ecografico e CT) hanno dimostrato la presenza di numerosi calcoli nel parenchima delle ghiandole parotidi, e l’ostruzione del dotto di Stenone destro. Antibiotici e farmaci anti-infiammatori sono stati somministrati per via endovenosa; al secondo giorno di ricovero, durante il massaggio manuale della ghiandola, si è verificata l’esplusione spontanea di un calcolo dalla ghiandola parotide destra, con immediato miglioramento dei sintomi. I pazienti affetti da sindrome di Sjögren e con reperti radiologici positivi per calcolosi delle ghiandole parotidi devono essere seguiti nel tempo, per meglio controllare possibili recidive di scialoadenite e poter effettuare la diagnosi precoce di un MALT linfoma, eventualmente associato.

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Figures

Fig. 1
Fig. 1
US examination of parotid glands revealing obstruction of hilum of right Stensen’s duct by a calculus (black arrow). Pa-renchymal heterogeneity with presence of hypoechoic areas (white arrows).
Fig. 2
Fig. 2
CT scan of parotid regions (two axial sections) showing multiple calculi in parenchyma of both parotid glands (superficial and deep lobe of glands).
See this image and copyright information in PMC

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