Parotid gland involvement as an initial presentation of Wegener's granulomatosis

Wegener's Granulomatosis Presenting as Unilateral Parotid Enlargement

“…Specks et al, 15 who published the largest case series of limited WG involving the salivary glands, stated that the morbidity and mortality is less with this presentation because biopsy specimens are readily obtainable and that early treatment of limited WG may prevent progression to systemic disease. Despite better prognosis, patients with limited WG of the salivary gland are at risk of serious complications if the treatment is delayed 17 . Although it appears that most untreated patients will progress to the systemic form, it is unpredictable over what time span this transition will occur 15 …”

“…It is unclear whether the development of the facial paralysis in this case was caused by direct nerve injury sustained from exposure in the wound bed or from a primary neuropathy secondary to disease. In instances of parotid gland involvement, there has been only one report of a spontaneous facial paralysis 17 . Additional cases of seventh nerve injury have been documented as a result of invasive surgical intervention 19 .…”

“…This occurrence can be found as part of the systemic form of the disease in which upper and lower respiratory tract and renal involvement coexist 4,12 . When salivary gland enlargement is seen as the initial manifestation of the limited form, it is usually accompanied with other signs of WG (i.e., sinusitis, epistaxis, hemoptysis) 13–17 . Recently, it was stated that major salivary gland enlargement in WG does not occur without head and neck or pulmonary symptoms and signs 16 …”

Wegener’s granulomatosis of the major salivary glands

“…Where imaging is reported, there has been no consistent or specific feature that has identified WG in the major salivary glands. Both diffuse (12, 13, 19, 22–24) and discrete (25–28) swellings have been reported with computerised tomography (CT) and magnetic resonance imaging (MRI). A discrete lesion is suggestive of an abscess or tumour, and a primary malignancy of the parotid was the working diagnosis in the case of Berge et al.…”

“…(28), and three in that of Chegar and Kelley (12), the third biopsy of the parotid showing necrotising granulomatous inflammation and small vessel arteritis. Other authors have identified histological features of WG in the salivary glands, but the changes were regarded as consistent with, rather than pathognomonic of, WG (26, 33). The case of Murty et al.…”