A 50-year-old man presents with bilateral parotid enlargement, dry eyes, and dry mouth. Salivary gland biopsy shows periductal lymphocytic infiltrate with glandular destruction. Serological tests are positive for anti-Ro (SS-A) antibodies. The most appropriate management is:

• A Superficial parotidectomy bilaterally
• B Corticosteroids alone at high doses
• C Rituximab as first-line treatment
• D Hydroxychloroquine and artificial saliva/tears (symptomatic management) ✓

Explanation

This is primary Sjogren's syndrome (sicca syndrome with anti-Ro antibodies and characteristic biopsy). Management is predominantly symptomatic: artificial saliva, salivary stimulants (pilocarpine), artificial tears, and hydroxychloroquine for systemic symptoms. Rituximab is reserved for severe systemic complications (vasculitis, renal involvement, MALT lymphoma risk). High-dose steroids are not standard first-line. Surgery is not indicated for the glandular enlargement of Sjogren's.

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.