A 35-year-old with known HIV presents with bilateral painless parotid gland enlargement. The most likely diagnosis is:

• A Acute bacterial parotitis
• B Benign lymphoepithelial cysts (lymphoepithelial disease) ✓
• C Sjogren's syndrome
• D Parotid sarcoidosis

Explanation

Benign lymphoepithelial lesions (cystic lymphoepithelial disease) in the parotid are a well-recognised manifestation of HIV infection, occurring in up to 5% of HIV-positive individuals. Multiple bilateral cystic parotid masses develop due to lymphoid hyperplasia with reactive cysts. Unlike Sjogren's, sicca symptoms and autoantibodies are absent. Acute bacterial parotitis is painful and typically unilateral. This finding may be the presenting feature of HIV and should prompt testing.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.