SHM Converge Scientific Abstract ePoster Gallery-In Bad Taste: A Case of Sarcoidosis Presenting as Xerostomia

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This case describes a 43-year-old man with a 30-pack-year smoking history who presented to the ED with dry mouth, fever, painful swallowing with solids, and a 40-pound unintentional weight loss over one month. On arrival, he was febrile, tachycardic, and hypotensive, with dry mucous membranes, submandibular lymphadenopathy, and non-tender bilateral parotid swelling. Laboratory testing showed anemia with markedly elevated inflammatory markers.<br /><br />He was initially treated for possible infection with broad-spectrum antibiotics, and an extensive workup for autoimmune, infectious, and cardiac causes was unrevealing, including SSA/SSB, rheumatoid factor, HIV, hepatitis C, blood cultures, fungal serologies, QuantiFERON-TB, ACE level, and TEE. FNA of the parotid glands and bronchoalveolar lavage were also nondiagnostic. Although he improved transiently and was started on pilocarpine for xerostomia, repeat chest CT showed worsening pulmonary infiltrates. EBUS with transbronchial biopsy then revealed non-caseating granulomas, confirming sarcoidosis. He was started on steroids with subsequent clinical improvement.<br /><br />The discussion highlights that sarcoidosis most commonly affects the lungs, while exocrine gland involvement is uncommon and usually presents as painless bilateral parotid enlargement and dry mouth. Constitutional symptoms such as fever and weight loss can occur, making diagnosis challenging. Fever in sarcoidosis is classically associated with Lofgren’s syndrome or Heerfordt-Waldenstrom syndrome, neither of which fit this patient’s presentation. Infectious etiologies must also be considered when fever and diffuse lung nodules are present. This case emphasizes that rare exocrine gland involvement can be an important clue to sarcoidosis, and early recognition and treatment may prevent progressive organ damage such as fibrosis.

Asset Subtitle

Monica Singh

Meta Tag

Author List Ethan Molitch-Hou, Monica Singh, Nhi Lam

Category Clinical Vignettes

Concept Sarcoidosis

Concept Noncaseating Granuloma

Concept Exocrine Gland

Concept Dry Mouth

Concept Salivary gland

Distinguished Non-Finalist

Presenter Organization University of Chicago Medical Center

Presenting Author Monica Singh

Track Adult

Keywords

sarcoidosis

parotid swelling

xerostomia

non-caseating granulomas

weight loss

fever

dry mouth

pulmonary infiltrates

steroid therapy

exocrine gland involvement

Sarcoidosis

Noncaseating Granuloma

Exocrine Gland

Dry Mouth

Salivary gland