PMC5274670_01
Head CT demonstrating left parotiditis.
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On day 7 after admission, the patient developed xerostomia and unilateral left parotiditis (Figure 1) that remitted under oral prednisolone 40 mg once a day.
Salivary gland scintigraphy showing decreased uptake in submaxillary and parotid.
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A salivary gland scintigraphy (99TcO4-) was performed and it revealed severely decreased uptake in submaxillary and parotid glands (Figure 2).
Submaxillary gland biopsy. (a) H&E 10 x 20:one focus of lymphocytic infiltrate (black arrow). (b) Immunohistochemistry:T lymphocytes (CD3+). (c) Immunohistochemistry:B lymphocytes (CD20+).
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Schirmer's test showed severe reduction of tear production (2 mm bilaterally after 5 minutes) and submaxillary gland biopsy (Figure 3) identified a multifocal inflammatory lymphocytic infiltrate with >1 focus/4 mm2 (1 focus = 50 lymphocytes), thus favouring the diagnosis of Sjogren syndrome.
Diagram representing the timeline of the relevant clinical events. The time on the arrow refers to the date of emergency room admittance.
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The patient had no psychiatric symptoms and was independent in all basic daily life activities (Figure 4).