Salivary endoscopy in a pediatric patient with HLA-B27 seropositivity and recurrent submandibular sialadenitis.

Abstract

Patients with human leukocyte antigen (HLA)-B27 seropositivity have a genetic predisposition to form spondyloarthropathies, especially ankylosing spondylitis. Other related inflammatory or autoimmune disorders include reactive arthritis, uveitis, psoriatic arthritis, and Crohn's disease. Although juvenile recurrent parotitis is not uncommon, recurrent submandibular sialadenitis is rare in pediatric patients. Sialadenitis is typically caused by salivary stones, infection, or duct stricture. To our knowledge, there has not been report of HLA-B27 positivity and recurrent sialadenitis described previously. We describe a patient with HLA-B27 seropositivity and multiple episodes of left submandibular sialadenitis who underwent diagnostic and therapeutic sialendoscopy. Previous treatment included antibiotics, sialogogues, warm compresses, and hydration before he underwent definitive sialendoscopy treatment at a tertiary care medical center. Salivary endoscopy showed salivary stasis and sludging within the left submandibular gland duct, with no salivary stones. Topical steroid was applied to the duct. At one year following his surgery, he has not had any recurrent episodes of sialadenitis. HLA-B27 seropositivity is associated with many inflammatory disorders; we report a case in which the patient had coexisting recurrent sialadenitis. In the pediatric population, sialadenitis is traditionally managed with antibiotics and supportive care, however our patient underwent salivary endoscopy. Sialendoscopy is an emerging modality that potentially avoids radiation exposure from CT or sialography and should be considered as another preferred treatment option. More investigation is required to prove a possible correlation between existing HLA-B27 and the propensity to develop this clinical problem.

• Authors: Amy M Nguyen, Carrie L Francis, Christopher G Larsen
• Journal: International journal of pediatric otorhinolaryngology (Int J Pediatr Otorhinolaryngol) Vol. 77 Issue 6 Pg. 1045-7 (Jun 2013) ISSN: 1872-8464 [Electronic] Ireland
• PMID: 23639340 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• HLA-B27 Antigen

Topics

• Child
• Endoscopy (methods)
• Follow-Up Studies
• HLA-B27 Antigen (immunology)
• Humans
• Male
• Recurrence
• Risk Assessment
• Serologic Tests
• Severity of Illness Index
• Sialadenitis (diagnostic imaging, immunology, surgery)
• Submandibular Gland (diagnostic imaging, physiopathology)
• Tomography, X-Ray Computed (methods)
• Treatment Outcome