A 45-year-old woman presents with bilateral parotid swelling, dry eyes, and dry mouth. On serology, she is anti-Ro/SSA positive. Salivary gland ultrasound shows parenchymal inhomogeneity with multiple hypoechoic foci. Salivary gland biopsy shows periductal lymphocytic infiltration with focus score of 3. The diagnosis is:

• A Mikulicz disease (IgG4-related sclerosing disease)
• B Sarcoidosis (Heerfordt syndrome)
• C HIV-associated salivary gland disease
• D Primary Sjogren's syndrome ✓

Explanation

The triad of bilateral parotid enlargement, xerophthalmia (dry eyes), and xerostomia (dry mouth) with positive anti-Ro/SSA antibodies and minor salivary gland biopsy focus score ≥1 (lymphocytic foci per 4 mm² of glandular tissue) meets classification criteria for primary Sjogren's syndrome. A focus score of 3 indicates significant lymphocytic infiltration. IgG4-related disease (Mikulicz) shows elevated serum IgG4 and IgG4+ plasma cell infiltration. Heerfordt syndrome is parotid enlargement with uveitis and facial palsy in sarcoidosis.

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.