Clinical Submandibularchronicsialadenitis presenting with

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Clinical Submandibularchronicsialadenitis presenting with

Transcript Of Clinical Submandibularchronicsialadenitis presenting with

Postgrad Med J: first published as 10.1136/pgmj.66.781.949 on 1 November 1990. Downloaded from http://pmj.bmj.com/ on June 23, 2022 by guest. Protected by copyright.

Postgrad Med J (1990) 66, 949 - 950

© The Fellowship of Postgraduate Medicine, 1990

Clinical Reports
Submandibular chronic sialadenitis presenting with alcohol-induced pain
C.C. Okany', I. Akinsetel and 0.0. Akinyanju2
Departments of 'Haematology and 2Medicine, College ofMedicine, University ofLagos, P.M.B. 12003,
Lagos, Nigeria

Summary: A 32 year old man with alcohol-induced pain over a right submandibular swelling is described. Excision biopsy ofthis swelling revealed chronic sialadenitis and the symptoms promptly ceased following this excision. We speculate on the possible pathophysiological mechanism.

Introduction
The association between alcohol-induced pain and Hodgkin's disease was first noted by Hoster in 1950.1 Since then several other authors2-6 have also reported similar findings, so much so that alcoholinduced pain is now commonly listed in textbooks as a hallmark of Hodgkin's disease, albeit an uncommon one. Apart from Hodgkin's disease, alcohol-induced pain has also been reported less frequently in other neoplastic diseases like car-
cinomas of the pancreas,57 bronchus,58 cervix,
bladder, nasopharynx, breast and also in nonHodgkin's lymphoma.5' It has also been reported in a malignant intracranial chordoma9 and in non-neoplastic conditions like fractured hip bone, acute pyogenic lymphangitis,4 Brodie's abscess and
pyogenic osteomyelitis.'0 We hereby report a case
of alcohol-induced pain seen in a patient with chronic sialadenitis of the submandibular gland.
Case report A 32 year old businessman was referred with a 3-month history of intermittent neck pain and a 3-week history of a right submandibular swelling. Pain was aching in nature but progressively got more intense and it took the patient some time to realize that the pain usually came on a few minutes after he had drunk some beer. He drank lager beer frequently and was in the habit oftaking about 2 or 4 pints at a time. Initially he got some relief from the pain by taking aspirin tablets. About 3 weeks before the patient presented to us he noticed a swelling at the right submandibular area, where the
Correspondence: C.C. Okany, M.B., F.M.C.P. (Nig.) Accepted: 25 April 1990

pain was usually maximal. This swelling gradually increased in size and the intensity of the pain worsened. The patient then reported to his family clinic from where he was referred to us as possibly a case of Hodgkin's disease with an alcohol-induced pain.
He was seen by us during one ofhis bouts ofpain which started about an hour after he drank 2 pints of beer. The pain was so intense that the patient actually rolled on the floor and needed pethidine 100 mg intramuscularly to control. Apart from the firm, slightly tender and non-mobile lump at the right submandibular region measuring about 2 cm by 3 cm, there were no other physical findings. The patient was admitted for excision biopsy. The histopathological diagnosis was chronic sialadenitis ofthe submandibular salivary gland with no evidence of malignancy. We have since followed him up for 2 years and there has been no recurrence of the neck pain even though he has resumed his beer drinking habits.
Discussion
Alcohol-induced pain had been previously thought to occur almost exclusively in Hodgkin's disease. However, the finding of this symptom in a variety of diseases, some of which are not neoplastic, indicates that it is not specific for Hodgkin's disease. The mechanism of pain following alcohol ingestion is not known although oedema,' alcoholinduced vasodilation,2'4 and accumulation of acetaldehyde as a result of tumour production of alcohol dehydrogenase in the case of tumours," have been variously suggested as possible mechanisms. It is quite conceivable that our patient's symptoms could be similar to those ofpatients with

Postgrad Med J: first published as 10.1136/pgmj.66.781.949 on 1 November 1990. Downloaded from http://pmj.bmj.com/ on June 23, 2022 by guest. Protected by copyright.

950 CLINICAL REPORTS

alcohol-associated pancreatitis. Both the pancreas and the salivary glands are exocrine glands with certain morphological similarities. In the case of alcohol-associated pancreatitis, repeated episodes of acute pancreatitis result ultimately in chronic pancreatitis with variable acute exacerbation fol-

lowing each ingestion of alcohol.'2 In a small percentage of these patients only minimal amounts of alcohol are known to trigger off severe pan-
creatitic pain.'3 We speculate that this same pathophysiological mechanism might be respon-
sible for the symptoms in our patient.

References
1. Hoster, H.A. Hodgkin's disease. Am J Roentgenol 1950, 64:
913-918.
2. Bichel, J. & Bastrup-Masden, P. Alcohol pain in Hodgkin's disease. Lancet 1953, i: 764-766.
3. Hall, C.A. & Olson, K.B. Alcohol-induced pain in Hodgkin's disease. N Engl J Med 1955, 253: 608-609.
4. Conn, H.O. Alcohol-induced pain as a manifestation of Hodgkin's disease. Arch Intern Med 1957, 100: 241-247.
5. Brewin, T.B. Alcohol intolerance in neoplastic disease. Br
Med J 1966, 2: 437-441. 6. Atkinson, K., Austin, D.E., McElwain, T.J. & Peckham, M.J.
Alcohol pain in Hodgkin's disease. Cancer 1975, 37:
895-899.
7. James, A.H., Harley, H.R.S., Norton, E.H. & Storring, F.K. Alcohol-induced pain due to carcinoma. Lancet 1957, i:
299-301.

8. Wanka, J. Alcohol-induced pain associated with adenocarcinoma of bronchus. Br Med J 1965, 2: 88-89.
9. Perkin, G.D. Alcohol-induced pain in chordoma. Br Med J 1973, 3: 478.
10. Alexander, D.A. Alcohol-induced pain in Hodgkin's disease (Letter). Br Med J 1953, 2: 1376.
11. Rees, G.J.G. Is alcohol intolerance in cancer patients explained by tumour production of alcohol dehydrogenase? (Letter). Eur J Clin Oncol 1989, 25: 1123.
12. Wormsley, K.G. Disease of the pancreas. In: Weatherall, D.J., Ledingham, J.G.G. & Warrell, D.A. (eds) Oxford Textbook of Medicine. Oxford University Press, Oxford, 1983, pp. 12.156-12.168.
13. Joske, R.A. Aetiological factors in the pancreatitis syndrome.
Br Med J 1955, 2: 1471-1481.
DiseaseHodgkinPatientPainSymptoms