3 years ago

Diagnostic différentiel des syndromes secs et parotidomégalies

Alice Tison, Guillermo Carvajal Alegria, Valérie Devauchelle-pensec, Divi Cornec

Publication date: September 2018

Source: Revue du Rhumatisme Monographies, Volume 85, Issue 4

Author(s): Alice Tison, Guillermo Carvajal Alegria, Valérie Devauchelle-Pensec, Divi Cornec

Résumé

La sécheresse buccale et oculaire est une plainte très fréquente, augmentant avec l’âge, et entraînant une altération profonde de la qualité de vie. Plusieurs pathologies peuvent être à l’origine d’un syndrome sec, parmi lesquelles le syndrome de Sjögren primitif (SSp). Le SSp est caractérisée par un syndrome sec oculaire et buccal, associé fréquemment à une augmentation de volume des glandes salivaires, en raison d’une infiltration lymphocytaire des glandes exocrines salivaires et lacrymales. Des manifestations systémiques sont également possibles chez la moitié des patients, et la principale complication est l’apparition d’un lymphome non hodgkinien. Le clinicien doit savoir écarter les diagnostics différentiels, pour reconnaître précocement les pathologies justifiant des traitements spécifiques. Cette revue présente certaines autres causes de syndrome sec (médicamenteux, infections virales chroniques, maladie du greffon contre l’hôte) et de gonflement des glandes salivaires (granulomatose avec polyangéite, sarcoïdose, maladie liée aux IgG4…), qu’il faut savoir évoquer chez un patient présentant un tableau de SSp atypique.

Abstract

Eye and/or mouth dryness (or sicca syndrome) is a very common complaint, increasing with age, and causing a profound decrease of the quality of life. Several conditions can cause a sicca syndrome, including primary Sjögren's syndrome (pSS). pSS is characterized by sicca syndrome, frequently associated with recurrent swelling of the salivary glands, due to a lymphocyte infiltration of the exocrine glands. Systemic manifestations are also possible in half of the patients, and the main complication is the development of non-Hodgkin's lymphoma. The clinician must know how to rule out several differential diagnoses, in order to recognize early the conditions that require specific treatments. This review presents some other causes of sicca syndrome (medications, chronic viral infections, graft-versus-host disease) and swelling of the salivary glands (granulomatosis with polyangiitis, sarcoidosis, IgG4-related disease…), which could be mistaken for atypical pSS.

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