Favorable Response to Systemic Corticosteroids as Supportive Diagnostic Evidence in Sarcoidosis: A Case Report

Sarcoidosis can be difficult to diagnose when salivary and lacrimal gland involvement resembles Sjögren disease or IgG4-related disease.A 58-year-old woman with a history of previously treated papillary thyroid carcinoma presented with subacute bilateral mandibular pain, parotid enlargement, and periorbital swelling.Computed tomography showed enlargement of the parotid and lacrimal glands, proptosis, and mediastinal and mesenteric lymphadenopathy.Serum angiotensin-converting enzyme was elevated, serum calcium was normal, and the reported autoimmune serological tests were negative.Parotid biopsy showed lymphocytic inflammation with epithelioid and multinucleated giant cells.Cervical lymph node biopsy demonstrated non-necrotizing granulomatous lymphadenitis without evidence of epithelial malignancy in the sampled tissue.The reported microbiological investigations were negative.These findings favored sarcoidosis, although the salivary gland histology raised the possibility of seronegative Sjögren disease.Oral prednisolone at 30 mg daily was followed by rapid improvement in glandular swelling and pain during one week of inpatient observation.Outpatient outcomes were unavailable.The response increased confidence in the working diagnosis when considered alongside the biopsy and imaging findings.This case describes the contribution of treatment response to diagnostic assessment while acknowledging its limited specificity.