The 515th case:dry mouth and dry eyes, parotid gland enlargement, pulmonary patchy shadows, muscular nodules
10.3760/cma.j.cn112138-20250503-00251
- VernacularTitle:第515例——口眼干、腮腺肿大、肺部斑片影、肌肉多发结节
- Author:
Jie WANG
1
;
Xiaoping LIU
;
Yanyan DONG
;
Rui LI
;
Gailian ZHANG
Author Information
1. 山西省人民医院风湿免疫科，太原 030012
- Publication Type:Journal Article
- Keywords:
Sarcoidosis;
Clinical manifestations;
Glucocorticoids
- From:
Chinese Journal of Internal Medicine
2025;64(12):1255-1260
- CountryChina
- Language:Chinese
-
Abstract:
A 72-year-old male patient presented with dry mouth and dry eyes, accompanied by decreased vision for more than 3 months, and the symptoms worsened over 5 weeks with parotid gland enlargement. PET/CT revealed increased metabolic activity in multiple nodules involving the lymph nodes, lacrimal glands, parotid glands, lungs, spleen, and muscles. Serum angiotensin-converting enzyme was significantly elevated. Biopsies of the parotid gland and lymph nodes revealed a large number of granulomatous lesions. The patient was given prednisone tablets combined with mycophenolate mofetil immunotherapy. Subsequently, the bilateral parotid gland swelling subsided, and the pulmonary patchy shadows, splenic nodules, and muscular nodules all either regressed or disappeared. A diagnosis of sarcoidosis involving multiple organs was established. However, during treatment, the pulmonary patchy shadows reappeared. After increasing the hormone dose, the pulmonary imaging manifestations again diminished or vanished, indicative of recurrent sarcoidosis. Therefore, atypical pulmonary manifestations of sarcoidosis may easily result in missed or incorrect diagnoses, emphasizing the importance of multisite histopathological biopsy. Besides, a favorable treatment response serves as additional supportive evidence for the diagnosis. Maintaining vigilance for disease recurrence is essential during hormone and immunosuppressive therapy.
