Eosinophilic Sialodochitis: A Rare Condition That Could Be Diagnosed Only Through Sialendoscopy
One evening in the mid-2010s, Sharon Robertson’s face swelled after eating. “I had a stone in one of my salivary gland ducts, and it popped out on its own.” This was a first clue that would lead to her eventual diagnosis. Eventually her family practitioner referred her to an ENT physician, who attempted to perform a sialendoscopy (endoscopy of the salivary gland ducts), but he was unable to perform the procedure due to narrowing and blockage.” She then saw an infectious disease specialist, an endocrinologist, a neurologist, a hematologist, and finally another ENT. Between 2019 and 2020, she underwent three sialendoscopy procedures.
“Despite the procedures, my condition continued to worsen and my quality of life was diminishing rapidly,” she says. “I was in pain daily and frequently had to squeeze mucus out through my salivary ducts to reduce the swelling.”
When Robertson and her husband moved to Houston, a local ENT referred her to Sancak Yuksel, MD, an associate professor in the Department of Otorhinolaryngology at UTHealth Houston and one of a handful of otolaryngologists in the country who treat salivary gland disease. In May 2021, Dr. Yuksel performed right submandibular and right parotid sialendoscopy.
“She did very well with the parotid gland surgeries, but her symptoms in the submandibular glands recurred,” he says. “When a patient has multiple gland disease, usually there’s a systemic disorder. Because of her long history of swelling and infection in the parotids and submandibular glands, we looked for possible Sjögren’s syndrome, a systemic autoimmune disease that causes insufficient moisture production in certain glands, including the salivary glands.”
During a subsequent sialendoscopy procedure, Dr. Yuksel found tiny lesions in her ducts and biopsied them. “It turned out that Mrs. Robertson has a very rare allergic infection of the salivary ducts, called eosinophilic sialodochitis, similar to allergic asthma but unusual to find in the salivary glands,” he says.
Dr. Yuksel referred her to an allergist, who initiated monthly injections of benralizumab, a new monoclonal antibody marketed under the name Fasenra®, which eliminates eosinophils and treats allergy and allergy-related conditions. “She has good saliva flow in all four glands, which gave her significant relief, and most of her symptoms improved,” he says.
“I cannot even tell you what a difference this has made in my life,” Robertson says. “I take monthly injections, alternating with Nucala®, a similar monoclonal antibody. The injections have reduced my inflammation and the amount of mucus in my glands. I’m not cured and may still need periodic sialendoscopy for flare-ups, but my treatment has been totally life changing. Dr. Yuksel is absolutely wonderful.”