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Parotidite recorrente juvenil… nem sempre é o que parece
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Abstract(s)
RESUMO
Introdução: A parotidite recorrente juvenil (PRJ) é uma inflamação recidivante idiopática da glândula parótida, geralmente
associada a sialectasia não-obstrutiva. A síndrome de Sjögren
(SS), rara em idade pediátrica, pode apresentar-se nesta faixa
etária sob a forma de parotidites de repetição.
Caso clínico: Menina, de 13 anos, que no quarto episódio
de tumefação e dor parotídea, iniciou investigação etiológica
que revelou glândulas parótidas ecograficamente com textura
heterogénea e múltiplas calcificações punctiformes, título ANA
elevado (1:1280) com padrão mosqueado, anticorpos Anti-SSA
e Anti-SSB positivos, assim como o fator reumatóide, hiper-gamaglobulinémia e elevação da imunoglobulina G. Verificou-se, também, elevação da creatinofosfoquinase, da transamínase
glutâmico-oxalacética e da transamínase glutâmico-pirúvica.
A biópsia das glândulas salivares minor foi compatível com
diagnóstico de SS. Iniciou terapêutica com hidroxicloroquina e
corticóide oral em baixa dose com resposta clínica favorável.
Discussão/Conclusão: A idade de aparecimento da tumefação
parotídea ajuda no diagnóstico diferencial entre PRJ
idiopática e uma etiologia inß amatória crónica. O envolvimento
muscular está descrito no SS primário e tem um espectro clínico
e patológico variado, sendo que a miosite subclínica surge numa
percentagem que varia entre os 5% e os 37%.
ABSTRACT Introduction: Juvenile recurrent parotiditis (JRP) is a relapsing inflammation of the parotid gland, usually associated with non-obstructive sialectasis. The Sjögren syndrome (SS), rare in children, may present at this age, in the form of recurrent parotiditis. Case Study: Female, 13 years, in the fourth episode of parotid swelling and pain, begins investigating: ultrasound of the parotid glands revealed heterogeneous texture and multiple punctiforme calcifications, high ANA (1:1280) title, with speckled pattern, auto-antibodies anti-SSA, anti-SSB and Rheumatoid Factor positive, hyper-gamaglobulinemia and elevated Immunoglobulin G. We also observed elevation of Creatinofosfoquinase, Glutamic Oxaloacetic Transaminase and Glutamic Pyruvic Transaminase. A minor salivary gland biopsy was consistent with a diagnosis of SS. Treatment was started with systemic steroids combining hydroxychloroquine during exacerbations, with clinical improvement. Discussion/conclusion: The age of onset of parotid swelling helps in differentiation between JRP idiopathic and other clinical entities. The muscle involvement occurs in primary SS and has a varied clinical and pathological spectrum, subclinical myositis occurs in a percentage that varies between 5% and 37%.
ABSTRACT Introduction: Juvenile recurrent parotiditis (JRP) is a relapsing inflammation of the parotid gland, usually associated with non-obstructive sialectasis. The Sjögren syndrome (SS), rare in children, may present at this age, in the form of recurrent parotiditis. Case Study: Female, 13 years, in the fourth episode of parotid swelling and pain, begins investigating: ultrasound of the parotid glands revealed heterogeneous texture and multiple punctiforme calcifications, high ANA (1:1280) title, with speckled pattern, auto-antibodies anti-SSA, anti-SSB and Rheumatoid Factor positive, hyper-gamaglobulinemia and elevated Immunoglobulin G. We also observed elevation of Creatinofosfoquinase, Glutamic Oxaloacetic Transaminase and Glutamic Pyruvic Transaminase. A minor salivary gland biopsy was consistent with a diagnosis of SS. Treatment was started with systemic steroids combining hydroxychloroquine during exacerbations, with clinical improvement. Discussion/conclusion: The age of onset of parotid swelling helps in differentiation between JRP idiopathic and other clinical entities. The muscle involvement occurs in primary SS and has a varied clinical and pathological spectrum, subclinical myositis occurs in a percentage that varies between 5% and 37%.
Description
Keywords
Hidroxicloroquina miosite parotidite recorrente síndrome Sjögren Hydroxychloroquine myositis recurrent parotitis Sjögren Syndrome
Citation
Nascer e Crescer 2013; 22(1): 25-29