Recurrent parotitis and Sjögren's syndrome

Common Characteristics and Clinical Management Recommendations for Juvenile Recurrent Parotitis: A 10-Year Tertiary Center Experience

Objective

Juvenile recurrent parotitis (JRP) is a rare disease that may adversely affect normal development and quality of life. The objective of this study was to report on the demographics, characteristics, and treatment outcomes of JRP and to offer evidence-based management recommendations.

Study Design

Retrospective review.

Setting

A single tertiary care pediatric teaching hospital.

Methods

Medical records, imaging studies, and laboratory findings over a 10-year period were retrospectively collected and reviewed, resulting in 41 patients with JRP between the ages of 8 months and 16 years.

Results

Black males aged 2 to 8 years were most commonly affected by JRP. Overall, 18 (44%) patients received ≥3 antibiotics, and 17 (42%) underwent sialendoscopy for treatment. Over 75% of patients had no JRP recurrences after 3 sialendoscopies. The most common imaging approach was computed tomography (42%), and the most frequent laboratory results were elevated amylase (83%) and C-reactive protein (82%). Atopy (61%) and excess weight (42%) were routinely associated with JRP, especially in severe cases.

Conclusion

JRP workup and treatment plans should begin with the least burdening modalities, including over-the-counter analgesics, minimal laboratory studies in the acute phase, and ultrasonography over computed tomography. Clindamycin is an effective initial antibiotic of choice, and severe recurrences may be controlled with sialendoscopy. Optimizing the health of patients with JRP includes managing comorbidities, especially of atopic and overweight origins, which are associated with more severe cases.

Childhood Sjogren's syndrome: An Italian case series and a literature review-based cohort

OBJECTIVE

Sjogren's syndrome (SS) is a chronic autoimmune disease with a highly variable presentation. This study aims to describe childhood SS (cSS) features to help guide clinicians in their consideration of and workup for cSS.

METHODS

We retrospectively reviewed medical records of patients with cSS referred to three Italian pediatric rheumatology centers from 2015 to 2019 and we conducted a literature review of cSS. Statistical analysis was performed to detect associations between clinical/laboratory features.

RESULTS

We reviewed 12 cases (9 female) followed in 3 Italian centers and 240 cases (191 female) in the published literature reporting individual information. The median age at disease onset was 10 years for both cohorts. The most frequently reported clinical SS-specific feature was parotitis in both cohorts (67% each). Extraglandular manifestations were very common and joint involvement was the most frequent. In the cluster analysis, we identified a significant association between parotitis and younger patients (< 11 years). We verified the presence of the main SS features (exocrine gland inflammation, exocrine gland dysfunction, and presence of autoantibodies) in the Italian cohort and the literature review-based cohort: 92% and 80% of the cohorts, respectively, had at least 2/3 main characteristics.

CONCLUSION

We described cSS features with relative frequencies and we found that parotid involvement was related to cSS in younger patients. The majority of patients showed various combinations of exocrine gland inflammation, exocrine gland dysfunction, and presence of autoantibodies giving a theoretical basis for future research to pave the way for the development of cSS specific diagnostic criteria.

The correlation of immunologic derangement and juvenile recurrent parotitis: an investigation of the laboratory immunological observation

BACKGROUND

Juvenile recurrent parotitis (JRP) is defined as recurrent parotid inflammation, generally associated with nonobstructive sialectasis of the parotid gland. In addition, the etiology remains unclear, probably immunologically mediated.

AIM

The purposes of the present study were to report the relationship between JRP and immune function from the measurement of the JRP patients' immunoglobulins and T-lymphocyte subset.

METHODS

Immunologic assay from 2014 to 2017 of 100 children diagnosed with JRP at Shanghai Ninth Hospital compared with the 100 normal children by age.

RESULTS

The CD4 level of JRP children aged >6 years was significant lower than the one of JRP preschool children (p < .05), while the IgG level was significant higher than the one of the JRP preschool children (p < .05). In comparison with the normal children, the value of CD8 T cells, immunoglobulin G (IgG), immunoglobulin E (IgE), immunoglobulin A (IgA) and C3 (p < .01) of JRP children was significant higher, while the value of CD4 T cells was lower (p < .01) in spite of age. What is more, the value of CD8 T cells of JRP preschool children was much significant higher than the one of the normal preschool children (p < .01).

CONCLUSION

The immune function of JRP patients may become disorder: the suppression cellular immune function and inadequate humoral immune expression.

Juvenile recurrent parotitis: clinical, sialographic and ultrasonographic features

OBJECTIVE

Juvenile recurrent parotitis (JRP) is a rare salivary gland disease of obscure aetiology that affects children. The aim of this study was to investigate the patterns of clinical presentation, and the sialographic and ultrasonographic features of JRP in Sri Lankan children.

METHODS

The authors analysed the hospital records of 26 subjects who had been diagnosed with JRP between January 2003 and April 2006.

RESULTS

The subjects consisted of 15 males and 11 females (male:female ratio=1.4:1). The age range of the sample was 2.5-16 years (mean=8.4 years). The age of onset was biphasic, with two major peaks at 6 years (n=6) and 10 years (n=5) (mean=6.73 years). Unilateral involvement was seen in 69.2% of patients. The commonest clinical features were swelling (100%), pain (80.8%) and fever (50.0%). The average frequency of recurrences of JRP in 18 patients was 7.1 times per year. The average duration of an individual episode, also in 18 patients, was 5.44 days. Sialography in 17 patients had revealed punctate sialectasis, whereas ultrasonography in 16 patients had demonstrated multiple hypoechoic areas and heterogeneous echoes

CONCLUSIONS

This study documents the clinical features of JRP in Sri Lankan children. It has established the usefulness of sialography and ultrasonography in the diagnosis of JRP.

Pediatric parotitis: a 5-year review at a tertiary care pediatric institution

BACKGROUND

Parotitis is a well recognized entity in the adult population, however there are very few studies concerning the clinical presentation and management of this condition in children.

OBJECTIVES

To characterize pediatric parotitis in a tertiary care setting, with the goal of clarifying management recommendations and outcomes.

METHODS

The charts of all pediatric patients with a diagnosis of parotitis treated at a tertiary care academic institution from 1999 to 2004 were reviewed. The management of inpatients and outpatients were characterized to define differences in presentation and care.

RESULTS

Twenty-one children (6 months-15 years) with a diagnosis of parotitis were identified. Thirteen (62%) children were treated as inpatients, of which seven (54%), had significant medical co-morbidities. The most common clinical presentations of the inpatient group included dehydration (46%), fever (38%) and leukocytosis (46%). Two inpatients (15%) required surgical drainage due to abscess formation. Eight children (38%) were treated as outpatients, none with associated co-morbidity, fever, leukocytosis, or complication due to infection. All outpatients were treated with oral antibiotics or conservative therapy with eventual resolution.

CONCLUSIONS

Parotitis in the pediatric population is uncommon. The presence of a significant co-morbidity, fever, or leukocytosis may require inpatient therapy and imaging if patients fail to improve with medical therapy. Other than abscess drainage, surgery for parotitis in children is not routinely recommended.

Recurrent parotitis of childhood

BACKGROUND

Recurrent parotitis (RP) of childhood is a rare condition of unknown aetiology, probably immunologically mediated.

OBJECTIVE

To review the clinical presentation, diagnosis and management of RP of childhood.

METHODS

Retrospective study from 1983 to 2004 of children diagnosed with RP of childhood at a tertiary children's hospital.

RESULTS

We identified 53 children, 37 (70%) male and 16 (30%) female. The age of onset was biphasic, with peaks at 2-5 years of age and at 10 years. The commonest symptoms were swelling (100%), pain (92.5%) and fever (41.5%). Symptoms usually lasted 2-7 days with a median of 3 days. The mean frequency was 8 episodes per year. The diagnosis was often delayed, >1 year in 70% of patients, maximum 8 years. The most common diagnoses, before the definitive diagnosis of RP, were mumps (21%), 'infection' (15%) and stones (11%). Sialogram (57%) and/or ultrasound (41%) showed sialectasis in 81% of patients. Over half the patients (54%) were given antibiotics at least once to treat the parotitis. Two children had hypogammablobulinaemia, one child had human immunodeficiency virus infection, and one child had Sjogren's syndrome. Two children had high titre antinuclear antibodies.

CONCLUSIONS

Recurrent parotitis had a biphasic age distribution. The major clinical features that distinguish it from other causes of parotid swelling are the lack of pus and recurrent episodes. A clinical diagnosis can often be confirmed by ultrasound. Antibiotics do not have a role in treatment. Affected children should be screened for Sjogren's syndrome and immune deficiency.

Recurrent parotitis in selective IgA deficiency

Recurrent parotitis is an uncommon condition in children. In most cases the etiology is unknown, although the disease is occasionally associated with viral infections, autoimmune disorders and immunodeficiency. We describe, for the first time, a child with recurrent parotitis and isolated immunoglobulin A (IgA) deficiency, without autoimmune disease. As IgA is the main immunoglobulin secreted into the mucosal surfaces, including that of the respiratory and gastrointestinal tracts, and into the saliva, the lack of IgA may be involved in the pathogenesis of recurrent parotitis. We recommend that IgA and other immunoglobulins be tested in all cases of recurrent parotitis.