Unilateral Dacryoadenitis as the First Symptom of Systemic Lupus Erythematous

This case report focuses on a patient with systemic lupus erythematous whose first symptom was dacryoadenitis. A 42-year-old Asian woman presented with a 3-day history of left periorbital swelling and pain. Gross examination revealed left periorbital swelling with no definite tenderness. Initial computed tomography with contrast showed diffuse enhancement and enlargement of the left lacrimal gland with adjacent fluid collection, indicating periorbital soft tissue swelling. She was diagnosed with left dacryoadenitis and treated with intravenous methylprednisolone (60 mg/day) and oral prednisolone (10 mg/day). Over the next 6 months, she experienced numerous instances of recurrence, which was shortly responsive to oral and intravenous high-dose steroids. Immunosuppressive therapy was selected, and upon conducting laboratory tests, she was diagnosed with systemic lupus erythematous. Since then, the patient has undergone treatment involving hydroxychloroquine (200 mg/day) and azathioprine (50 mg/day) with no recurrence.