1. iPhone

2. I-Ta Tsai Intern, National Yang-Ming University Case Presentation

3. General Data 54-year-old female A bank clerk, retired

4. Chief Complaint Progressive painful swelling mass over left cheek for 1 week

5. Intermittent asymmetric migratory oligoarthritis 199 4 199 5 199 9 2005/0 4 '06/0 3 0808 0909 '07/0 8 41 y/o

6. Right cheek painful swelling Dry mouth and eyes 199 5 199 4 199 9 2005/0 4 '06/0 3 0808 0909 '07/0 8 42 y/o Parotitis

7. Right cheek painful swelling 199 9 199 4 199 5 2005/0 4 '06/0 3 0808 0909 '07/0 8 46 y/o Sjögren’s syndrome Parotid gland biopsy

8. …… 199 4 199 5 2005/0 4 '06/0 3 0808 0909 '07/0 8 199 9

9. Right cheek painful swelling for 3 weeks 199 4 199 5 2005/0 4 '06/0 3 0808 0909 '07/0 8 52 y/o 199 9 Sialoscintigraphy TM joint CT scan

10. Bilateral cheeks painful swelling for 3 weeks 199 4 199 5 2006/0 3 2005/0 4 0808 0909 '07/0 8 53 y/o 199 9 Herpes zoster, right, V 2

11. Bilateral cheeks painful swelling for 1 week 199 4 199 5 2006/0 8 2005/0 4 '06/0 3 0909 '07/0 8 53 y/o 199 9 Gallium67 scan MTP pulse therapyy

12. Left cheeks painful swelling for 3 weeks 199 4 199 5 2006/0 9 2005/0 4 '06/0 3 0808 '07/0 8 53 y/o 199 9 Sonography CT of oral cavity Abscess culture: Prevotella melaninogenica

13. Left cheek painful swelling for 1 week 199 4 199 5 2007/0 8 2005/0 4 '06/0 3 0808 0909 54 y/o 199 9 Sonography

14. Past History No HTN/DM/hepatitis No allergy Cesarean sections Chronic ulcer

15. Personal History No smoking No alcohol consumption No betelnut chewing

16. Family History Father: dry mouth

17. Review of Systems No fever / weight loss / skin rash / petechia / dry eye / dental caries / cough / dysuria / diarrhea / arthralgia / Raynaud's phenomenon

18. Physical Exam. Facial swelling No skin rash / petechia / flank knocking pain / neck, inguinal LAP

19. Impression Recurrent parotitis or lymphadenitis with abscess formation, related to Sjögren’s syndrome ? Lymphoma ? Kikuchi disease ?

20. Data Trends

21. Hospitalization Augmentin Abscess culture: Strep. viridans Sialoscintigraph y Prophylactic benthazine PCN monthly Sonograph y

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