Sjögren's syndrome with bilateral multiple parotid sialolithiasis – Diagnostic approach and management

Sjögren's syndrome is a chronic autoimmune disorder that primarily affects exocrine glands, leading to dryness in the eyes, mouth, and other mucosal areas. It may present as a primary condition or with other autoimmune diseases. The main pathology is lymphocytic infiltration of the exocrine glands, resulting in xerostomia and xerophthalmia. Though dryness of eyes, dry mouth, and parotid enlargement are considered the triad of Sjögren's syndrome, it can rarely present with sialolithiasis. This case involves a 52-year old female with a 3-year history of dry eyes, dry mouth, fatigue, and joint pain. Laboratory tests were positive for anti- SSA (Ro) and anti-SSB (La) antibodies. CBCT imaging revealed bilateral multiple parotid sialoliths. Minor salivary gland biopsy revealed lymphocytic infiltration, confirming the diagnosis of Sjögren's syndrome. The patient was treated with artificial tears, oral hydration, and systemic prednisolone and chloroquine. Follow-up showed significant improvement in symptoms, energy levels, and joint symptoms. This case emphasizes the importance of diagnosis and symptomatic management to alleviate discomfort and prevent complications, including dental decay and corneal damage. Regular follow-up is crucial for managing systemic involvement and ensuring long-term health.