case_images: PMC5274670_01
case_images: Head CT demonstrating left parotiditis.
case_images: CRINM2017-5696512.001.jpg
case_images: PMC5274670_01_CRINM2017-5696512.001.jpg
case_images: fig1
case_images: 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.
case_images: Salivary gland scintigraphy showing decreased uptake in submaxillary and parotid.
case_images: CRINM2017-5696512.002.jpg
case_images: PMC5274670_01_CRINM2017-5696512.002.jpg
case_images: fig2
case_images: A salivary gland scintigraphy (99TcO4-) was performed and it revealed severely decreased uptake in submaxillary and parotid glands (Figure 2).
case_images: 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+).
case_images: CRINM2017-5696512.003.jpg
case_images: PMC5274670_01_CRINM2017-5696512.003.jpg
case_images: fig3
case_images: 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.
case_images: Diagram representing the timeline of the relevant clinical events. The time on the arrow refers to the date of emergency room admittance.
case_images: CRINM2017-5696512.004.jpg
case_images: PMC5274670_01_CRINM2017-5696512.004.jpg
case_images: fig4
case_images: The patient had no psychiatric symptoms and was independent in all basic daily life activities (Figure 4).