ABSTRACT
Cysts in the parotid region are more common in the gland than in the duct. Isolated cyst of parotid duct is a rare presentation. The treatment for most of the cystic lesions of the parotid or the parotid duct is the excision of the cyst with superficial parotidectomy. However, these lesions can be approached intra-orally for marsupialization achieving the same surgical results with less morbidity. This paper presents a rare case of parotid duct cyst which was managed by intraoral drainage and marsupialization. A 53-year-old female presented with swelling in the right cheek, associated with frequent fluid drainage inside the oral cavity for four months. Radiology and Fine needle aspiration revealed a benign parotid duct cyst with normal parotid gland. It was managed by a simple surgical technique of marsupialization. The patient was followed up for 1 year with no evidence of recurrence. Marsupialization obviates the need for parotidectomy in the simple cystic lesion of the parotid duct, unlike the cystic lesion in the gland per se and also reduces risk of recurrence. The simplicity and lack of major complications make it an effective treatment for salivary duct cysts.
ABSTRACT
INTRODUCTION: Azathioprine hypersensitivity can occasionally present as Sweet-like syndrome, a dose-independent side effect characterized by the unanticipated onset of macules, papules, and pustules. CASE PRESENTATION: A 35-year-old woman with systemic lupus erythematosus presented with complaints of generalized maculopapular rash, facial swelling, and bilateral lower extremity edema with a duration of 4 days and a 2-day history of constitutional symptoms within 2 weeks of the beginning of azathioprine therapy to treat existing lupus nephritis (class 2/3). DISCUSSION: Patients who experience azathioprine hypersensitivity syndrome can present with erythema nodosum, small-vessel vasculitis, acute generalized exanthematous pustulosis, Sweet syndrome, and nonspecific dermatosis. The following signs and symptoms are used as criteria to diagnose drug-induced Sweet syndrome: (a) abrupt onset of painful erythematous plaques, (b) histopathological evidence of dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis, (c) temperature higher than 39.7°C, (d) temporal relationship between drug ingestion and clinical presentation, and (e) temporal resolution of lesions after drug withdrawal. Our patient met three out of five criteria and was diagnosed with Sweet-like syndrome. CONCLUSION: Our case highlights the uncommonly presented azathioprine-induced Sweet-like syndrome that occurs abruptly after the commencement of the offending drug. This diagnosis can be established through basic laboratory workup and skin biopsy findings.
