Nguyen Amy M, Francis Carrie L, Larsen Christopher G
Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City, KS 66160, USA.
Int J Pediatr Otorhinolaryngol. 2013 Jun;77(6):1045-7. doi: 10.1016/j.ijporl.2013.03.027. Epub 2013 Apr 29.
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.
人类白细胞抗原（HLA）-B27血清学阳性的患者具有形成脊柱关节病的遗传易感性，尤其是强直性脊柱炎。其他相关的炎症性或自身免疫性疾病包括反应性关节炎、葡萄膜炎、银屑病关节炎和克罗恩病。虽然青少年复发性腮腺炎并不少见，但复发性下颌下腺炎在儿科患者中很少见。涎腺炎通常由涎石、感染或导管狭窄引起。据我们所知，此前尚未有关于HLA-B27阳性与复发性涎腺炎的报道。我们描述了一名HLA-B27血清学阳性且多次发生左下颌下腺炎的患者，该患者接受了诊断性和治疗性涎腺内镜检查。在他于一家三级医疗中心接受确定性涎腺内镜治疗之前，既往治疗包括使用抗生素、催涎剂、热敷和补液。涎腺内镜检查显示左下颌下腺导管内有涎液淤滞和淤积，未见涎石。向导管内应用了局部类固醇。手术一年后，他未再出现涎腺炎复发。HLA-B27血清学阳性与许多炎症性疾病相关；我们报告了一例患者同时存在复发性涎腺炎的病例。在儿科人群中，涎腺炎传统上采用抗生素和支持性治疗，然而我们的患者接受了涎腺内镜检查。涎腺内镜检查是一种新兴的方法，有可能避免CT或涎腺造影带来的辐射暴露，应被视为另一种首选的治疗选择。需要更多的研究来证实现有的HLA-B27与发生这一临床问题的倾向之间可能存在的相关性。
