Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Parotid enlargement - I have seen this twice now. Work up and FNA biopsies (chronic inflammation)are unremarkable to date. The first got gradually better with coincident with effective antiretroviral therapy. The second just presented. Etiology? Possibly med related?
Many thanks
Trevor Hawkins, M. D.
Associate Clinical Professor, Dept. Family Practice, University New Mexico
Medical Director, Southwest CARE Center, Santa Fe, NM
I have seen a number of cases of Parotid enlargement, all bilateral. The literature shows that it is more common in children and early in the disease.
The vast majority are caused by a benign lymphoepithelial infiltrate that causes the occurence of cysts, probably by cystic degeneration, or by ductal obstruction. The source of the infiltrate is thought to be migration of salivary gland lymphoid tissue into the gland although how HIV causes this is obscure.
CT and/or biopsy should rule out B cell Lymphoma, more likely in unilateral disease.
Mumps and bacterial parotitis are associated with fever, pain etc and tumours are rarely bilateral or cystic and are slow growing.
The problem is cosmetic and usually goes away with HAART. Surgery is risky for damage to the facial nerve. In persistent cases, aspiration works temporarily, radiation has been used with varying success and sclerosing agents may be tried.
I did have one very persistent case that ended up in surgery (patients wish) and all went well.
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