The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Heerfordt-Waldenstrom Syndrome: A Case Report 

Alex Kloster1*, Ziad Abuhelwa1, Adam Meisler2, Barat Venkataramany1, Ragheb 
Assaly3

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Department of Neurology, The University of Toledo, Toledo, OH 43614 
3Division of Pulmonary and Critical Care Medicine, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: Alex.Kloster@utoledo.edu

Published: 05 May 2023 

Background: Heerfordt-Waldenstrom Syndrome(HWS) is a variant of sarcoidosis, which presents with 
swelling of the Parotid or salivary glands, facial nerve paralysis and anterior uveitis. The incidence is 
rare, with only 6% of sarcoidosis patients having parotid gland enlargement, and 5% of patients with 
cranial nerve palsy.   

Case Presentation: A 44-year-old woman with non-significant past medical history presented to the 
emergency department with several weeks of low back and flank pain. She was also complaining of 
weakness, weight loss, voice hoarseness and worsening shortness of breath. Six months prior to her 
presentation, she was diagnosed with a left sided facial nerve palsy. Examination revealed bilateral 
parotid gland enlargement, left ptosis, left facial drooping and cervical, axillary and femoral 
lymphadenopathy. Workup for malignancy was negative. Tests for syphilis, acid-fast bacilli and fungal 
infection were negative. ACE levels found to be increased. CT neck and chest revealed extensive 
lymphadenopathy, multiple lung nodules and infiltrative densities replacing bilateral parotid glands. 
Lymph node biopsy confirmed revealed necrotizing granulomas, confirming diagnosis. Patient was 
initiated on Solumedrol 125mg bid, after which she endorsed improvement in voice hoarseness, 
shortness of breath and pain. She was transitioned to prednisone 60mg daily and azathioprine 50mg 
daily at discharge and will follow up with rheumatology and pulmonology for further management.  

Discussion/Conclusion: Heerfordt-Waldenstrom syndrome should be considered in the differential for 
new onset facial nerve palsy without a clear source. When only two of the symptoms are present, it is 
considered incomplete HWS. 

https://dx.doi.org/10.46570/utjms.vol11-2023-708 

https://dx.doi.org/10.46570/utjms.vol11-2023-708
mailto:Alex.Kloster@utoledo.edu