Rosai Dorfman Disease presenting as unilateral chronic parotitis

We report a 48-year-old man who presents with a 20-month history of left parotid enlargement despite treatment with antibiotics and steroids. He presented with a non-painful palpable mass in his left parotid without facial weakness or otologic symptoms. Fine needle aspiration was inconclusive, and an attempted excisional biopsy was aborted due to involvement of the facial nerve and suspicion of lymphoma. Subsequently, he underwent a total parotidectomy with facial nerve preservation. The specimen yielded results that were consistent with Rosai-Dorfman disease. Of note in our patient is the lack of cervical lymphadenopathy, which classically presents with this condition. Head and neck extranodal involvement, while not unusual for Rosai-Dorfman, is rarely seen in the parotid. Previous reports of this disease found in the parotid indicate an underlying autoimmune process, which was not found in this patient.