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129:A diagnosis of Human Immunodeficiency Virus (HIV) from a parotid swelling[AAOM2021]
EP36075
Poster Title: 129:A diagnosis of Human Immunodeficiency Virus (HIV) from a parotid swelling[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Delia Smyth, Angela Hancock, Philip Stenhouse
Affiliations: Oral Maxillofacial Surgery Department, King's College Hospital, United Kingdom
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 300
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Poster Information
Abstract: Background

Salivary gland swellings can be caused by multiple reasons. Sialadenitis, salivary stones, autoimmune diseases, viral infections and salivary gland neoplasms can all result in salivary gland swellings. Thorough examination and special investigations should be undertaken to provide the appropriate management.

Case Summary

A patient presented to the Oral Maxillofacial department following referral from his general medical practitioner with a six-month history of swelling to his right parotid, not associated with mealtime syndrome. He had no history of tenderness or erythema to the area. His medical history included type two diabetes and hypercholesterolemia.

The examination revealed a discreet swelling associated with a lump in the right parotid area. It was mobile, not tender and no pus was expressed on palpation.

An ultrasound was undertaken at this appointment, which showed a large, well-defined hypo echoic area, which measured 8mmx7mmx11mm.

The differential diagnosis at this point included Sjorgren’s syndrome, benign lymphoepithelial cysts of HIV and sarcoidosis. A fine needle aspirate, a chest x-ray and blood tests for Sjorgren’s, sarcoidosis and HIV were organised.

The fine needle aspirate revealed a mixture of small and medium sized lymphoid cells within a cystic background containing groups of benign oncocytic epithelial cells. No granulomas were seen on the fine needle aspiration and the chest x-ray was clear. As a result, sarcoidosis was unlikely. All tests were negative for Sjorgren’s disease.

However, the patient tested positive for HIV.

As a result, he was referred to the appropriate Infectious Disease department for ongoing management and treatment.

Conclusion

This case demonstrates the importance of considering all differential diagnosis when assessing and examining a patient presenting with salivary gland swellings. Although the most frequent diagnosis can be of a salivary stone or sialadenitis, it is important to bear in mind other pathologies.

It also highlights the importance of follow up of patients as well as correlating the clinical picture with histology and radiology.
Summary: Salivary gland swellings can be caused by multiple reasons. Sialadenitis, salivary stones, autoimmune diseases, viral infections and salivary gland neoplasms can all result in salivary gland swellings. Thorough examination and special investigations should be undertaken to provide the appropriate management.

Ask the author questions about this poster:smythd7@tcd.ie
References: 1. Sekikawa Y, Hongo IHIV-associated benign lymphoepithelial cysts of the paro)d glands confirmed by HIV-1 p24 an)gen immunostainingCase Reports 2017;2017:bcr-2017-221869.
2. Naidoo M, Singh B, Randial PK, Moodley J, Allopi L, Lester B. Lymphoepithelial lesions of the paro)d gland in the HIV era--a South African experience. S Afr J Surg 2007;45:136-8,140
3. Uccini S, D'Offizi G, Angelici A, Prozzo A, Riva E, Antonelli G, et al. Cys)c lymphoepithelial lesions of the paro)d gland In HIV-1 infec)on. AIDS Pa)ent Care STDS 2000;14:143-7
4. Syebele K, Bütow KW. Compara)ve study of the effect of an)retroviral therapy on benign lymphoepithelial cyst of paro)d glands and ranulas in HIV-posi)ve pa)ents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:205–10.doi:10.1016/j.tripleo.2010.09.067
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