Читать книгу Salivary Gland Pathology - Группа авторов - Страница 132

HIV infection is associated with numerous pathologic processes involving the salivary glands, with the parotid gland being the most common. Parotid gland enlargement is estimated to occur in 1–10% of HIV‐infected patients (Shanti and Aziz 2009). HIV‐associated salivary gland disease (HIV‐SGD) is a term used to describe the diffuse enlargement of the salivary glands. HIV‐SGD may affect patients throughout all stages of the infection, and may be the initial manifestation of HIV infection (Schiodt et al. 1992).

Figure 3.17. A 9‐year‐old girl with a left parotid swelling with overlying erythema of skin but no signs of acute infection (a). The patient underwent left superficial parotidectomy and excision of a submandibular lymph node. Histopathology showed noncaseating granulomas (b), and cultures showed mycobacterium avium‐intracellulare. Two months following the parotidectomy, a left submandibular lymph node became enlarged (c) and was treated with medical therapy.

Figure 3.18. Axial (a) and coronal (b) CT images demonstrating contrast enhancement of bilateral submandibular and parotid glands in a patient with a clinical viral prodrome.

Patients with HIV‐SGD present with a history of nontender swelling of one or more of the salivary glands (Figure 3.19). These swellings may fluctuate, but are generally persistent. Imaging studies are generally beneficial to diagnose lymphoepithelial cysts in this patient population that may clinically resemble the nontender swellings of the parotid glands in this patient population. Decreased salivary gland function results in xerostomia and sicca symptoms. This sicca symptom complex mimics Sjögren syndrome and has resulted in the classification of another HIV‐related salivary gland process known as the diffuse infiltrative lymphocytosis syndrome (DILS). This pathologic process is characterized by the presence of persistent circulating CD8 lymphocytes and infiltration of organs by CD8 lymphocytes that occur predominantly in the salivary glands and lungs. While DILS appears clinically like Sjögren syndrome, it can be differentiated by the presence of extraglandular involvement of the lungs, kidneys, and gastrointestinal tract. In addition, Sjogren's autoantibodies will be absent in patients with DILS.

Medical management of HIV‐SGD involves the use of antiretrovirals, observing meticulous oral hygiene, and the use of sialogogues. Corticosteroids may also be of use.