Clinical reasoning and decision-making in practice. A man with swelling of both corners of the jaw

A 33-year-old man was referred to an oral surgeon by his general practitioner because ofa bilateral swelling in both jaws. A CT-scan of the head showed enlargement of the parotid glands. After exclusion of mumps and sialolithiasis the patient was treated with oral antibiotics. The swelling failed to improve and the patient was sent to an internist. A repeated medical history revealed that he also had symptoms of sicca syndrome. Sj?gren's syndrome was excluded only after negative immunoserological tests and sublabial salivary gland biopsy. A chest X-ray showed enlarged bilateral hilar lymph nodes, confirming the diagnosis of sarcoidosis. A gallium scintigraphy provided further support for this diagnosis. No treatment was initiated and the patient recovered slowly afterwards.