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Response of Lymphoepithelial Parotid Cysts to Antiretroviral Treatment in HIV-Infected Adults

Donald E. Craven, MD; Robert A. Duncan, MD, MPH; John R. Stram, MD; Carl J. O'Hara, MD; Kathleen A. Steger, RN, MPH; Kristin Jhamb, MD; and Lisa R. Hirschhorn, MD, MPH
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From the Boston University School of Medicine, Boston Medical Center, and Boston University School of Public Health, Boston, Massachusetts; Lahey Hitchcock Clinic, Burlington, Massachusetts; and Dimock Community Health Center, Roxbury, Massachusetts. Acknowledgments: The authors thank Maria Tetzaguic for assistance in manuscript preparation; Dr. Margaret Sullivan for patient information and manuscript review; and Dr. Sanjay Ram, Colleen LaBelle, RN, Carrie Grodman, RN, and Sharon Irvin, LPN, for patient information. Requests for Reprints: Donald E. Craven, MD, Boston Medical Center, Dowling 3 North, 1 Boston Medical Center Place, Boston, MA 02118. Current Author Addresses: Dr. Craven and Ms. Steger: Boston Medical Center, Dowling 3 North, 1 Boston Medical Center Place, Boston, MA 02118.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(6):455-459. doi:10.7326/0003-4819-128-6-199803150-00006
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Background: Surgical resection has been the usual therapy for HIV-infected patients with lymphoepithelial parotid cysts.

Objective: To study antiretroviral therapy for lymphoepithelial parotid cysts.

Design: Case series.

Setting: HIV outpatient clinics.

Patients: HIV-infected patients with lymphoepithelial parotid cysts.

Intervention: Antiretroviral therapy.

Measurements: Change in size of the parotid cyst, CD4 lymphocyte count, and HIV viral load.

Results: Nine HIV-infected adults presented with chronic, large parotid cysts, eight of which were bilateral. In at least seven patients, the cysts were the initial sign of HIV infection. In six patients, the cysts resolved completely with combination antiretroviral therapy. Four of these patients also received prednisone. Three patients who did not comply with antiretroviral therapy had partial responses followed by relapses.

Conclusions: Parotid cysts are an unrecognized sign of early HIV infection. These cysts respond to combination antiretroviral therapy, with or without corticosteroids. Surgical resection should be reserved for patients in whom medical therapy has failed or those who refuse or are poorly compliant with medical therapy.


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Figure 1.
Lymphoepithelial parotid cyst disease in an HIV-infected patient (patient 2) before (left) and after (right) combination antiretroviral therapy.
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