Swelling of the parotid gland with night sweat, fever and weight loss: a rare differential diagnosis

History and clinical findings: A 29-year-old patient complained of recurren t swelling of the eyelids and cheeks, fever, diffuse headaches, night sweat and weight loss (8 kg during 8 weeks). Both parotid glands showed swelling which were solid, plain and non-painful to pressure. Palpation did not rev eal enlarged lymph nodes. There were no other patholocigal findings except for anisocoria and disturbed motoric function of the right eye's pupil. Investigations: Laboratoy findings, chest X-ray, abdominal sonography and i lium crest biopsy showed no signs of lymphoma or other tumour. MRT showed e nlarged parotid glands and hypointensitiy of a few small (up to 2 cm) areas . Because of these findings Heerfordt-syndrome with involvement of the thir d cranial nerve and the lachrymal glands was suspected and verified by paro tid biopsy. Treatment and course: Under corticosteroid therapy started with 80 mg/d sym ptoms rapidly ceased. Therapy was continued for one year. 8 months after th erapy had been stopped the patient had no complaints and investigations sho wed no signs of recurrence nor pulmonary or any other organ manifestation. Conclusion: If swelling of the parotid glands with night sweat, fever and w eight loss occur, parotid biopsy should be performed early to exclude malig nancy. With parotid gland biopsy also diagnosis of other diseases which hav e similar signs, such as Sjogren-syndrome and parotid gland sarcoidosis, ca n be established early.