A 42-Year-Old Woman with Known HIV Infection Comes to the Physician

question 176

Multiple Choice

A 42-year-old woman with known HIV infection comes to the physician with left-sided facial swelling and pain.  She describes similar episodes over the last 6 months that last several days and then slowly subside.  During these episodes, she has difficulty eating and sleeping on her left side.  She also complains of occasional dry mouth, heartburn, and nocturnal wheezing.  Her CD4 count was 450/µL 2 months ago.
Her temperature is 36.7 C (98 F) , blood pressure is 108/78 mm Hg, pulse is 70/min, and respirations are 16/min.  There is a tender, nonerythematous, spongy swelling in the preauricular area extending to the angle of the mandible.  Cranial nerve examination is unremarkable.
Which of the following is the most likely diagnosis?

• A)Follicular lymphoma
• B)Pleomorphic adenoma
• C)Sialolithiasis
• D)Sjögren's syndrome
• E)Viral sialadenitis

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