HIV-Associated Salivary Disease — ORE Part 1 MCQ

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HardOral PathologyHIV-Associated Salivary DiseaseORE Part 1

An adult with confirmed HIV infection has persistent, painless bilateral parotid enlargement. There is no fever, acute tenderness or focal facial nerve deficit. Which lesion is the most likely explanation?

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Correct answer: C — Benign lymphoepithelial cysts

The best answer is C. HIV-associated salivary gland disease commonly presents with persistent, painless enlargement of one or both parotid glands; benign lymphoepithelial cysts are its characteristic and commonest parotid lesion. Bilaterality and established HIV infection are the key discriminators. Warthin tumours can be bilateral but are usually smoking-associated neoplasms and are not specifically linked to HIV. Pleomorphic adenomas are generally solitary unilateral masses. Sarcoidosis may cause bilateral salivary enlargement, but the stem provides the stronger disease-specific association with HIV. Sjögren-related sialadenitis can also cause parotid swelling and lymphoepithelial change, but it is not the most likely explanation in this HIV-positive presentation.

Reference: Nkuna T, Maharaj S, Hari K. Benign Lymphoepithelial Cyst of Parotid Glands in HIV Infected Patients on Anti-Retroviral Therapy: A Narrative Review. Indian Journal of Otolaryngology and Head & Neck Surgery. 2023. https://pubmed.ncbi.nlm.nih.gov/26571922/