A 50 yo M with hx of pancreatitis and asthma presents with chronic facial swelling.
Questions to Ask?
- Symmetry?
- Swelling in other body areas?
- Any new medications or other exposures?
- Sicca symptoms?
Clinical Presentation & History
- Exam reveals bilateral lacrimal, parotid, and submandibular gland swelling
- Palpable cervical and axillary lymphadenopathy
- No fever, night sweats, weight loss, or other systemic symptoms
- Patient notes two episodes of idiopathic pancreatitis in the past 2 years, but has no symptoms at present, and the abdominal exam is unremarkable.
Diagnostic Workup
- Recommended labs: CBC w/ diff, CMP, ESR, CRP, HIV, IGRA, SPEP/SFLC, ANA, RF, SSA/SSB, IgG subsets, IgG4, IgE, C3, C4
- Recommended imaging: CT head and chest/abdomen/pelvis
Next Steps
- Broad imaging evaluation helps with disease characterization and identification of a biopsy target (likely head/neck gland in this case).
- Imaging and biopsy results, as well as any laboratory evidence of organ system compromise, would guide next steps.