Sarcoidosis Parotid — ORE Part 1 MCQ
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Correct answer: E — Sarcoidosis
Sarcoidosis is the correct answer. The combination of bilateral parotid enlargement, bilateral hilar lymphadenopathy, and elevated serum ACE is characteristic of systemic sarcoidosis with salivary gland involvement. Although ACE is a non-specific marker and cannot diagnose sarcoidosis alone, it is a supportive finding in the context of compatible clinical presentation and radiological findings. The explicit absence of xerostomia and xerophthalmia rules out primary Sjögren syndrome, which would present with sicca symptoms. Mumps is an acute infectious disease incompatible with these systemic findings. Bilateral Warthin tumours are extremely rare and unassociated with elevated ACE or hilar lymphadenopathy. HIV-associated salivary disease is not supported by the clinical presentation.
Reference: Glos NHS Pathology & South Tees NHS Pathology (ACE interpretation in sarcoidosis, 2022–2024); Yuvarajan et al. Sarcoidosis Diagnostic Score (2024); Dental recognition of sarcoidosis-parotid association in peer-reviewed literature. https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/angiotensin-converting-enzyme-ace/