JUVENILE RECURRENT PAROTIDITIS…NOT ALWAYS WHAT IT SEEMS
Keywords:Hydroxychloroquine, myositis, recurrent parotitis, Sjögren Syndrome
Introduction: Juvenile recurrent parotiditis (JRP) is a relapsing inflammation of the parotid gland, usually associated with non-obstructive sialectasis. The Sjögren syndrome (SS), rare in children, may present at this age, in the form of recurrent parotiditis.
Case Study: Female, 13 years, in the fourth episode of parotid swelling and pain, begins investigating: ultrasound of the parotid glands revealed heterogeneous texture and multiple punctiforme calcifications, high ANA (1:1280) title, with speckled pattern, auto-antibodies anti-SSA, anti-SSB and Rheumatoid Factor positive, hyper-gamaglobulinemia and elevated Immunoglobulin G. We also observed elevation of Creatinofosfoquinase, Glutamic Oxaloacetic Transaminase and Glutamic Pyruvic Transaminase. A minor salivary gland biopsy was consistent with a diagnosis of SS. Treatment was started with systemic steroids combining hydroxychloroquine during exacerbations, with clinical improvement.
Discussion/conclusion: The age of onset of parotid swelling helps in differentiation between JRP idiopathic and other clinical entities. The muscle involvement occurs in primary SS and has a varied clinical and pathological spectrum, subclinical myositis occurs in a percentage that varies between 5% and 37%.
Piltcher O. Afecções das glândulas salivares na infância. In:
Sih T, Chinski A, Eavey R, Godinho R. V Manual de otorrinolaringologia
pediátrica da Interamerican Association of
Pediatric Otorhinolaryngology (IAPO). 1.ª Edição. Brasil: Lis
GráÞ ca e Editora;2006:p127 -32.
Gajendra V, Nagabhushana D, Mamatha G, Annigeri R. Bilateral
Parotid Swelling in a child – A case report. Indian Soc
Pedodon Prev Dent 2004; 22:17 -20.
Chitre V, Premchandra J. Recurrent parotitis. Arch Dis Child
Miziara ID, Campelo S. Parotidite recorrente da infância: estudo
em longo prazo de cinco casos e revisão da literatura.
Rev Bras Otorrinolaringol 2005;71:570 -5.
Oliveira W, Assis L, Crosara S, Becker H, Guimarães R,
Oliveira J et al. Síndrome de Sjögren primário em crianças:
relato de caso. Rev Bras Cirurgia da Cabeça e Pescoço
Bricks LF. Parotidite recorrente da infância. Rev Paulista de
Pediatria 2007;25: 190 -2.
Woo P, Laxer M, Sherry D. Juvenile Dermatomyositis. Pediatric
Rheumatology in Clinical Practice. 1st Edition. London:
Springer Editors;2007:66 -76.
Houghton K, Malleson P, Cabral D, Petty R, Tucker L. Primary
Sjögren’s Syndrome in Children and Adolescents:
Are Proposed Diagnostic Criteria Applicable? J Rheumatol
Muscal E, DeGuzman M, Jung L, Flaitz C. Pediatric Sjogren
Syndrome. Disponível em: http://emedicine.medscape.com/
Cedalia A. Sjögren Syndrome. In: Kliegman RM, Behrman
RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics.
th Edition. Philadelphia: Saunders Editors; 2007:1028 -9.
Tucker LB. Sjögren syndrome In: Cassidy JT. Petty RE, Laxer
RM, Lindsley CB. Textbook of Pediatric Rheumatology. 6th
edition. Philadelphia: Saunders Elsevier; 2011:548 -65.
Panush R, Kramer N, Rosenstein E. Undifferentiated systemic
rheumatic (connective tissue) diseases and overlap
syndromes. Disponível em: http://www.uptodate.com/contents/
undifferentiated -systemic -rheumatic -connective -tissue-
-diseases -and -overlap -syndromes
Cervera R, Khamashta MA, Hughes GR. ‘Overlap’ syndromes.
Ann Rheum Dis 1990; 49:947 -8.
Hara T, Nagata M, Mizuno YU, Matsuo M, Ueda K, Recurrent
parotid swelling in children: clinical features useful for differential
diagnosis of Sjögren’s syndrome. Acta Paediatr 1992;
Aoki A, Ono S, Ueda A, Hagiwara T, Tsuji T, Misumi M, et al.
Myositis in primary Sjögren’s syndrome: clinical and pathological
report. Mod Rheumatol 2003; 13:57 -61.
Sjögren syndrome. Disponível em: http://www.mdconsult.
Venables PJ. Management of patients presenting with Sjögren
syndrome. Best Pract Res Clin Rheumatol 2006;
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