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Authors: Priti Dangayach, Baylor College of
Medicine, Class of 2011
Monisha Arya, MD, MPH, Assistant Professor of Medicine, Baylor
College of Medicine
Introduction: The combination of multiple
parotid cysts with diffuse cervical lymphadenopathy suggests the
diagnosis of benign lymphoepithelial cysts of the parotid gland, a
condition that may herald the diagnosis of HIV. Antiretroviral
therapy for this condition may be curative.
Case Presentation: A 36-year-old HIV-positive
woman with a CD4 count of 609 cells/µL developed acute
rightsided neck pain, which progressed to swelling above the
mandible within two weeks. She denied constitutional symptoms.
Physical examination revealed bilateral neck swelling and
tenderness, greater on the right side. Her neck ultrasound showed
bilateral, anechoic, and primarily cystic lesions in the parotid
glands. The cytopathology report after fine needle aspiration was
negative for malignancy. Subsequent computed tomography detected a
3-cm well-circumscribed homogenously hypodense cystic lesion in the
right parotid gland and a similar 1.2-cm lesion in the left.
Multiple small lymph nodes were present in the cervical and
supraclavicular chains bilaterally. Based on these characteristic
imaging findings of bilateral parotid cysts with associated
lymphadenopathy, these lesions were characterized as benign
lymphoepithelial cysts of the parotid gland, a condition
predominantly found among HIV-positive individuals. Our patient
underwent needle aspiration of the right cyst, with immediate
complete relief of her symptoms. However, within 3 weeks, the neck
pain and swelling reappeared prompting repeat aspiration.
Ultimately, twelve aspiration procedures were performed over four
years. The patient began highly active antiretroviral therapy for
her CD4 count of 264 cells/µL in July 2009. Now in December
2009, her CD4 count has increased, her viral load has become
undetectable, and her swelling has not reappeared. She has remained
symptom-free for five months, the longest duration of relief that
she has experienced in four years.
Discussion: In HIV-positive individuals,
lymphoepithelial cysts of the parotid gland are typically benign,
bilateral, multiple, and associated with lymphadenopathy. Several
approaches have been tried to manage lymphoepithelial cysts
including aspiration, surgery, steroids, and antiretroviral
treatment. Conservative management includes repeated aspirations.
Surgical resection leads to resolution of cysts, but is associated
with considerable risks. Antiretroviral therapy may be curative.
This case highlights the importance of suspecting benign
lymphoepithelial cysts of the parotid gland in HIV-positive
patients who present with neck swelling. Characteristic imaging
findings support this diagnosis. Limited published research
suggests that antiretroviral therapy may be curative. Notably,
benign lymphoepithelial cysts of the parotid gland can be the
presenting manifestation of HIV infection, and HIV testing should
be performed in patients who present with neck swelling and
characteristic imaging findings.
February Issue of IMpact