A 40 y.o. female pictured below comes to the office with swelling of both upper lids, mild shortness of breath and symptoms of dry eyes. One would expect to see as part of her work up:

A 40 y.o. female pictured below comes to the office with swelling of both upper lids, mild shortness of breath and symptoms of dry eyes.  One would expect to see as part of her work up:
  1. A monocytic B cell infiltrate of her lacrimal glands
  2. Pain on palpation of her lacrimal glands.
  3. An elevated ACE.
  4. A history of breast cancer.

Correct Answer: An elevated ACE.

An elevated ACE is associated with sarcoidosis, an inflammatory condition that affects the main lacrimal gland and can lead to ATD. Sarcoidosis is also associated with lung and subcutaneous nodules. It is generally not painful and pathology shows non-caseating granulomas.

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