Presentation
New onset of seizures and confusion. For workup. No significant past medical history. Incidental finding.
Patient Data
Incidental finding of lymphoepithelial lesions within the parotid glands bilaterally on contrast administration. In the context of the clinical presentation, mild global involutional change is inappropriate for age. There is no evidence of complicated intracranial sepsis or any epileptogenic foci identified.
There is nasopharyngeal lymphoproliferative hyperplasia.
Case Discussion
Identifying lymphoepithelial lesions of the parotid glands alludes to HIV and immune suppression in a highly prevalent local incidence. The usual differential diagnosis of Sjogren's syndrome and Mikulicz's syndrome still apply.
The presentation of confusion and seizure onset often portends a more sinister background. MRI studies and lumbar puncture, are often performed after HIV confirmation to confirm/exclude opportunistic intracranial sepsis/PML/HIV encephalopathy.
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