A 67-year-old woman presented with dry eyes, dry mouth, intermittent polyarticular nonerosive arthropathy, bronchial and bronchiolar involvement with bronchiectasis, peripheral sensory neuropathy, cryoglobulinemic vasculitis (IgM |gk paraprotein), pronounced hypergammaglobulinemia (|gg-globulin fraction, 28.6 g/L; reference interval, 8.0–13.5 g/L), and rheumatoid factor positivity (rheumatoid arthritis latex test, 728 IU/mL; reference interval, ≤40 IU/mL). Both parotid glands were enlarged, especially on the left side (Fig. 1). Puncture of a parotid cyst revealed benign material suggestive of a sialocoele (salivary cyst). The results of antinuclear antibody testing were negative (indirect immunofluorescence, screening dilution 1:40).Magnetic resonance image showing cystic enlargement of the left parotid gland (arrow).
Magnetic resonance image showing cystic enlargement of the left parotid gland (arrow).
- What is the most likely diagnosis?
- Which result is inconsistent with the clinical picture?
- What could be done to investigate the inconsistent results?
What Is Your Guess? Read the article by Xavier Bossuyt, et al., here for the answers.