Background/Objectives: Chronic and recurrent sialadenitis are inflammatory disorders of the major salivary glands often managed with repeated courses of systemic antibiotics, despite limited long-term efficacy and growing concerns regarding antimicrobial resistance. Minimally invasive intraductal therapies, including sialoendoscopy with irrigation, have emerged as effective alternatives aimed at addressing ductal obstruction and chronic inflammation while reducing antibiotic exposure. This study aimed to systematically review the available evidence on the effectiveness and safety of sialoendoscopy with intraductal irrigation in the management of chronic and recurrent sialadenitis, with particular attention to its potential antibiotic-sparing role. Methods: A literature review was conducted in accordance with PRISMA guidelines. Major scientific databases were searched to identify studies evaluating sialoendoscopy with intraductal irrigation in patients with chronic or recurrent sialadenitis. Study characteristics, patient populations, irrigation protocols, and clinical outcomes were extracted and qualitatively analyzed. Results: Sialoendoscopy with intraductal irrigation was associated with significant clinical improvement in more than two-thirds of patients, with complete or partial symptom resolution. The procedure demonstrated high technical feasibility and a favorable safety profile. Symptom control was maintained across most etiological subgroups. The need for prolonged or repeated systemic antibiotic treatment decreased following endoscopic intervention. Conclusions: Sialoendoscopy with intraductal irrigation may represent a promising and minimally invasive therapeutic option for chronic and recurrent sialadenitis and may contribute to improved antibiotic stewardship by reducing unnecessary systemic antibiotic use. These findings suggest that intraductal therapeutic strategies could be considered within evolving care pathways for chronic salivary gland disorders, aligning clinical management with broader public health efforts to combat antimicrobial resistance.

Not all cases of Exophthalmos are related to Graves' disease. Normal thyroid function test results should prompt extended differential diagnostics. IgG4-related disease (IgG4-RD) mimics various inflammatory, infectious, or neoplastic conditions. Diagnosis requires integration of clinical, laboratory, imaging, and histopathological findings. Early glucocorticoid therapy can reduce organ involvement and improve patient outcomes.

Radioactive iodine therapy (RIT) is commonly used as an adjuvant treatment for differentiated thyroid cancer (DTC). While its efficacy is well established, this therapy can cause radiation-induced damage to the salivary and lacrimal glands due to their ability to concentrate iodine. These adverse effects may lead to xerostomia, sialadenitis, or xerophthalmia. The aim of this review and meta-analysis was to estimate the prevalence and characteristics of salivary and lacrimal dysfunctions in patients treated with RIT for DTC. Following PRISMA guidelines, a systematic search was conducted in PubMed and Scopus databases to identify studies published between 2000 and 2024. Meta-analyses of prevalence and odds ratios were carried out using random-effects models to estimate the pooled prevalence of events and the influence of administered activity. Thirty-eight studies were included in the review, of which sixteen were retained for the meta-analyses. The pooled prevalence of xerostomia decreased from 60% (95%CI 28;85) at <2 months to 17% (95%CI 10;28) more than one year post-RIT. A significant association was observed between high levels- with study-specific thresholds - of administered I131 activity and the occurrence of xerostomia. Sialadenitis and lacrimal dysfunction were also frequently reported. Despite heterogeneity in protocols and assessment tools, most studies highlighted a frequently persistent impairment in many patients. This systematic review and meta-analysis highlighted the frequency and persistence of salivary and lacrimal dysfunctions following RIT.

Relapsing polychondritis is a rare immune-mediated inflammatory disorder characterized by the recurrent inflammation of cartilaginous structures, particularly the auricular, nasal, and respiratory tract cartilage. Airway involvement represents one of the most severe and potentially life-threatening complications. Approximately one-third of relapsing polychondritis cases are associated with other systemic autoimmune diseases. We report the case of a 50-year-old man presenting with inspiratory dyspnea, progressive dysphonia, bilateral auricular and nasal chondritis, inflammatory polyarthralgia, xerostomia, and xerophthalmia. Cervicothoracic computed tomography demonstrated diffuse circumferential thickening of the trachea. Bronchoscopy confirmed inflammatory tracheal involvement. Immunological testing revealed positive antinuclear antibodies with strongly positive anti-SSA and anti-SSB antibodies. Minor salivary gland biopsy showed grade IV chronic lymphocytic sialadenitis. A diagnosis of relapsing polychondritis associated with primary Sjögren's syndrome was established. The patient was treated with intravenous methylprednisolone followed by oral corticosteroids and hydroxychloroquine, resulting in marked clinical improvement. This case highlights the importance of systematic autoimmune screening in patients with relapsing polychondritis and emphasizes the need for early recognition of airway involvement to prevent irreversible structural damage.

Sjögren's disease is a chronic inflammatory autoimmune disease, which mostly affects women who suffer particularly from dryness of mucous membranes, especially in the eyes and the mouth, tiredness and potentially also extraglandular manifestations such as joint and muscle pain. In the initial diagnostic work up serological alterations especially autoantibodies against SS-A(Ro)/SS-B(La) and rheumatoid factors play an important role. The pathogenesis is not yet finally clarified but an important role of B cells can be assumed. To date mostly symptomatic treatment options to improve glandular functional deficits with respect to the sicca symptoms are available. Based on most recent publications there is justifiable hope that this could soon change, especially with respect to extraglandular manifestations. For this reason, it is particularly important that validated outcome parameters are available to enable proper evaluation of new treatment options. In this article the EULAR instruments Sjögren's syndrome disease activity index (ESSDAI) for documenting extraglandular manifestations and Sjögren's syndrome patient reported index (ESSPRI) as patient-reported outcome (PRO) have been translated and are here presented in detail. Both also represent the cornerstones of possible outcome instruments (STAR or CRESS) of the second generation, which are currently undergoing validation.

Thrombocytopenia is defined as a reduction in circulating platelet count below 1.5 L/μL, resulting from reduced platelet production or increased destruction secondary to infections, drugs, immune mechanisms, or systemic diseases. In this case, we report a 20-year-old young Indian female presenting with fever, fatigue, and bilateral parotid swelling with severe thrombocytopenia. Laboratory investigations revealed mild anemia, weakly positive antinuclear antibody, reduced salivary flow rate, and minor salivary gland biopsy showing focal lymphocytic sialadenitis, suggesting Sjögren's syndrome with secondary immune thrombocytopenia (ITP). The patient was started on oral steroids, and there was significant clinical improvement and improvement in thrombocytopenia. This case emphasizes the importance of evaluating autoimmune causes in unexplained thrombocytopenia in young patients and not ruling them out as a viral etiology.

Sjögren's syndrome (SS) is a chronic autoimmune disorder primarily affecting exocrine glands, characterized by dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). However, systemic manifestations, including pulmonary complications, are increasingly recognized. Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening presentation of SS, typically associated with vasculitis or coagulation abnormalities. We report the case of a 19-year-old male presenting with dyspnea and hemoptysis, later diagnosed with primary Sjögren's syndrome (pSS). Initial clinical assessment revealed respiratory failure with low blood oxygen levels (hypoxemia), bilateral ground-glass opacities on chest computed tomography (CT), and iron-storing macrophages (hemosiderin-laden) in bronchoalveolar lavage fluid, consistent with DAH. Subsequent autoimmune serology confirmed positivity for anti-Ro/Sjögren's-syndrome-related antigen A autoantibodies (SSA) and anti-La/Sjögren's-syndrome-related antigen B autoantibodies (SSB), while other autoimmune markers, including anti-neutrophil cytoplasmic antibodies (ANCA), were negative. Labial salivary gland biopsy demonstrated focal lymphocytic sialadenitis, confirming pSS according to European League Against Rheumatism (EULAR) criteria. Treatment involved high-dose corticosteroids, leading to complete resolution of symptoms and significant improvement in imaging results. The patient remained stable at follow-up. DAH should be considered a potential presentation of pSS, even in the absence of classical symptoms. Increased awareness of this rare complication can facilitate early diagnosis and improve outcomes.

IgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory disorder that can affect multiple organs, but involvement of the prostate is rare. Most reported cases of IgG4-related prostatitis are associated with multiorgan disease and present with lower urinary tract symptoms (LUTS). Herein, we present a rare case of IgG4-related prostatitis, which was detected by whole-body diffusion-weighted imaging with background body signal suppression (DWIBS) and was pathologically diagnosed by MRI-fusion target biopsy, accompanied by IgG4-related dacryoadenitis/sialadenitis and multiple lymphadenopathies. Oral prednisolone relieved symptoms including general malaise, weight loss, and LUTS, with decreases in serum IgG4 levels. At the same time, DWIBS showed a remarkable signal reduction in the prostate and other involved organs. The present case suggests the usefulness of DWIBS in detecting and monitoring IgG4-RD including IgG4-related prostatitis.

Minor salivary gland biopsy (MSGB) plays a pivotal role in the classification and diagnosis of Sjögren's disease, one of the most prevalent systemic autoimmune disorders within the spectrum of rheumatic diseases. Furthermore, it provides valuable phenotypic information about the patient, contributes to the assessment of disease prognosis, and serves as a reliable tool for monitoring therapeutic response. MSGB is also useful in the diagnosis of amyloidosis, sarcoidosis, IgG4 disease, or lymphoma. In recent years, less invasive techniques have become increasingly widespread and have been proposed as highly accessible procedures for rheumatologists-straightforward to perform and associated with minimal or no complications. Consequently, MSGB has become a key diagnostic and follow-up tool in the comprehensive management of the disease.