
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38104987
10.2169/internalmedicine.3014-23
Pictures in Clinical Medicine
Chronic Parotitis in Primary Sjögren's Syndrome
Horino Taro 1
1 Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Japan
Correspondence to Dr.　Taro Horino, horinott@yahoo.co.jp

18 12 2023
15 8 2024
63 16 23472348
4 10 2023
2 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
chronic parotitis
ectopic calcifications
Sjögren's syndrome
==== Body
pmcA 46-year-old woman presented with acute-onset inflammation and pain in both parotid glands. A physical examination revealed purulent discharge from Stensen's duct. Amylase levels were elevated to 1,206 U/L (normal range: 44-132 U/L), and IgG4 levels were 14.7 mg/dL (11-121 mg/dL). Serological anti-SSA/Ro antibody test results were positive, and a salivary gland biopsy revealed lymphocytic sialadenitis. Computed tomography (CT) revealed enlarged parotid glands with multiple punctate intraparenchymal calcifications (Picture A, horizontal section; Picture B, three-dimensional rendering). The patient was diagnosed with Sjögren's syndrome with acute exacerbation of chronic parotitis with multiple calcifications. Parotid gland sialadenitis, caused by salivary obstruction due to sialolithiasis, mucus plugging, and duct stenosis, is characterized by periprandial pain and inflammation (1). Two types of salivary gland calcifications occur in chronic recurrent sialadenitis: sialolithiasis (intraductal calculi in the primary branches of salivary ducts) and intraparenchymal calcifications residing within salivary gland tissues or terminal ducts within the gland (1). Bacterial parotitis and sialolithiasis commonly occur in the unilateral parotid gland. To our knowledge, there have been no reports of diffuse calcification of the parotid gland in diseases that cause bilateral parotid swelling (especially IgG4-related disease). Multiple bilateral parotid intraparenchymal calcifications are associated with Sjögren's syndrome (2), and diagnostic CT imaging features are suggestive of Sjögren's syndrome.

Picture.

The author states that he has no Conflict of Interest (COI).
==== Refs
1. Jáuregui E , Kiringoda R , Ryan WR , Eisele DW , Chang JL . Chronic parotitis with multiple calcifications: clinical and sialendoscopic findings. Laryngoscope 127 : 1565-1570, 2017.27861944
2. Sun Z , Zhang Z , Fu K , Zhao Y , Liu D , Ma X . Diagnostic accuracy of parotid CT for identifying Sjögren's syndrome. Eur J Radiol 81 : 2702-2709, 2012.22285605
