We report a case of granulomatous rosacea (GR) with parotid gland swelling and gallium 67 uptake in the lacrimal, parotid, and submandibular glands.
A 59-year-old Japanese man developed papular erythematous eruptions on his face and visited a dermatologist in March 2002. Contact dermatitis was diagnosed, and a systemic corticosteroid (prednisolone, 20 mg/d) was administered. The patient was referred to our hospital 1 month later because the eruptions continued to worsen and parotid gland swelling occurred. Physical examination revealed extensive edema and diffuse erythema of his entire face, with red papules, parotid gland swelling, and conjunctival injection (Figure 1A). Several erythematous macules were observed on his back, chest, and upper extremities. Clinical diagnosis by an ophthalmologist and otolaryngologist included scleritis, conjunctivitis, and parotiditis. Laboratory tests showed increased levels of serum amylase and C-reactive protein. Other findings, including autoantibodies, were unremarkable. Histopathologic examination of the erythema on the patient's cheeks revealed epithelioid granuloma with lymphocytic infiltrates at its periphery in the upper and middle dermis (Figure 1B). Because GR, sarcoidosis, and lupus vulgaris were considered possibilities, we performed additional examinations. The tuberculin test result was positive, but the chest radiograph revealed no abnormalities, and no mycobacterium was isolated. Angiotensin-converting enzyme, lysozyme, and calcium levels were within normal limits. Gallium 67 uptake occurred only in the lacrimal, parotid, and submandibular glands (Figure 2A). A final diagnosis of GR was made, and minocycline hydrochloride therapy (200 mg/d) was initiated.