A 28-year-old woman presents with low-grade fever, bilateral painless parotid swelling, anterior uveitis, and a left lower motor neuron facial palsy. Chest radiograph shows bilateral hilar lymphadenopathy. Serum calcium is elevated. What is the diagnosis?
- A Mikulicz disease
- B Heerfordt syndrome ✓
- C Kuttner tumour
- D Sjogren syndrome
Explanation
Heerfordt syndrome, or uveoparotid fever, is a presentation of sarcoidosis combining parotid enlargement, uveitis, fever, and cranial nerve palsies, most characteristically facial palsy. Hilar lymphadenopathy and hypercalcaemia support systemic sarcoidosis. Mikulicz disease describes painless lacrimal and salivary gland enlargement and lacks uveitis and facial palsy. Kuttner tumour is chronic sclerosing sialadenitis of the submandibular gland, usually unilateral and unrelated to uveitis. Sjogren syndrome causes dryness rather than uveitis or cranial nerve involvement.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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