Unmasking the Uncommon: A Challenging Case of suspected Eosinophilic Sialodochitis

Abstract

Introduction: Eosinophilic sialodochitis is a rare inflammatory disorder of the salivary glands, marked by eosinophilic infiltration, ductal obstruction, and recurrent swelling. Diagnostic confirmation is challenging due to its symptoms overlapping with other salivary gland disorders. We present a case of eosinophilic sialodochitis highlighting the complexities of diagnosis and treatment in the absence of surgical intervention. Case Discussion: A 65-year-old female presented with a 10-year history of recurrent swelling in the left parotid and submandibular glands, with occasional symptoms on the right side. Recurrent episodes, occurring 2-3 times per month, were not meal-related and were accompanied by itching, which subsided with antihistamines. Serial ultrasounds and sialograms demonstrated persistent mucous plugging and sialectasis, more pronounced on the left. Multiple sialendoscopies provided minimal relief. Recent allergy testing, conducted after an angioedema episode under general anaesthesia, showed a positive reaction to vecuronium, suggesting an underlying allergic tendency. However, no clear causative factor has been identified, leaving eosinophilic sialodochitis as a working diagnosis. The patient's reluctance for surgical intervention limits treatment options, posing a significant challenge in achieving symptom control through conservative measures alone. Conclusion(s): This case highlights the diagnostic uncertainty and therapeutic challenges of suspected eosinophilic sialodochitis, especially in patients avoiding surgery. Rare conditions like this underscore the need for further research into non-surgical treatments, which may provide valuable options for future cases where diagnosis remains elusive, and management is constrained.Copyright © 2025