SARS-CoV-2 associated unilateral parotitis in children: A case report and literature review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection usually affects the respiratory system; however, a number of atypical manifestations of this disease have also been reported, especially in children. The present study reports a case of a 12-year-old presenting with right unilateral parotitis and sialadenitis and SARS-CoV-2 infection. The young patient, after a 3-day history of fever, was brought to our clinic (Polyclinic University Hospital 'G. Rodolico', Catania, Italy) for the sudden onset of unilateral parotitis accompanied by sialadenitis and hyperaemia of the skin, which was tender to touch. The SARS-CoV-2 molecular swab was positive; the ultrasound of the affected region showed an increase in the volume of the parotid and sublingual gland and reactive lymph nodes compatible with parotitis and sialadenitis. This case suggests that, in the present Coronavirus disease 2019 pandemic, SARS-CoV-2 should be included in the differential diagnosis of parotitis and sialadenitis along with mumps and flue. Notably, a respiratory panel and serology for other potential causes are needed in case of parotitis-like disease.

Ultrasound-guided thread lifting for the prevention of parotid gland and diagnosing parotid duct complications

BACKGROUND

Thread lifting is a common minimally invasive plastic surgery procedure. Parotid gland injury caused by thread lifting is a known complication; however, visual evidence of this complication is lacking.

OBJECTIVES

This study aimed to present cases of parotid gland injury by thread lifting shown using ultrasound and to discuss the importance of ultrasound detection of the location of the parotid gland before thread insertion.

METHODS

This study included eight patients diagnosed with parotid gland perforation and one with parotid duct injury due to threads from November 2020 to October 2022.

RESULTS

Six patients showed tenderness and swelling, three were asymptomatic, and one with duct injury showed severe swelling and pain. Although the severity and duration of symptoms have differed, we confirmed the progress of improvement with conservative treatment and confirmed ultrasound findings progressed.

CONCLUSIONS

Using ultrasound to detect the parotid gland's location before thread lifting might reduce the chance of parotid duct injury. Identifying immediate parotid duct or gland injury with ultrasound can help to act quickly for delayed pain or swelling and reduce the likelihood of additional complications.

Coronavirus OC43 and Influenza H3N2 Concomitant Unilateral Parotitis: The Importance of Laboratory Tests in Mumps-Like Parotitis

Mumps is an acute generalized infection caused by a Paramyxovirus. Infection occurs mainly in school-aged children and adolescents and the most prominent clinical manifestation is nonsuppurative swelling and tenderness of the salivary glands, unilaterally or bilaterally. Negative serology for mumps requires a differential diagnosis with other infectious agents, but it is not routine. An 11-year-old girl presented with fever and right-sided parotitis and a negative serology for Mumps. A respiratory panel revealed the presence of Coronavirus OC43 and influenza virus H3N2. Parotitis may be caused by the parainfluenza virus, Epstein-Barr virus, influenza virus, rhinovirus, adenovirus, or other viruses in addition to noninfectious causes such as drugs, immunologic diseases, or obstruction of the salivary tract as predisposing factors. In this case, Coronavirus OC43 and influenza virus H3N2 were detected. The H3N2 has been already reported in the literature, whereas Coronavirus OC43 has never been associated with parotitis before; although, in the present case, the association of the two viruses does not let us conclude which of the two was responsible for the disease.

Juvenile Recurrent Parotitis: An Eight-Year-Old Boy With a Painful Acute Right-Sided Parotid Swelling

Juvenile recurrent parotitis (JRP) is a rare recurrent non-obstructive inflammatory swelling of the parotid gland occurring most commonly in children aged three to six years. JRP is usually idiopathic and presents as a painful swelling recurring on either side of the face at least twice within six months. We report the case of an eight-year-old Saudi boy with a painful acute right-sided parotid swelling and a history of similar occurrences bilaterally at least four times a year for two years. The routine laboratory investigations were unremarkable. Ultrasonography of the parotid glands suggested parotitis with cervical lymphadenopathy. He was treated conservatively and remained asymptomatic for a year. Although rare, an accurate diagnosis of JRP is possible with adequate history, physical examination, and lab investigations, supplemented with radiographic findings.

Pseudoaneurysm of the external carotid artery following parotitis: a case report

Pseudoaneurysms of the external carotid artery of nontraumatic causes are very rare; those of infectious causes in adults are also quite unusual and are often preceded by bacteremia. Infection-related cases such as the one described here are scarce in the literature since the complication is not often calculated or expected. We present a case report of an elderly female patient who, after dental treatment and parotitis, noticed a mass behind the right mandible. After examination, the case was diagnosed as a pseudoaneurysm of the external carotid artery of an infectious cause. Management could be by surgical intervention, but the high positioning of the pseudoaneurysm and the age of the patient were contraindications. The choice was made to avoid surgery and keep the patient under long-term follow-up; no increase in its mass was observed after 3 years of follow-up.

Mumps and Splenic Abscess: Is There a Link?

Mumps is an acute viral illness occurring in children and young adults transmitted via droplets. It is a vaccine-preventable illness caused by the mumps virus, an RNA (ribonucleic acid) virus belonging to theParamyxoviridaefamily. It typically presents with fever, parotitis, epididymo-orchitis, oophoritis, meningitis, encephalitis, pancreatitis and arthritis. Although viremia with multiorgan involvement is known to be commonly seen in mumps, there have been no reported cases of splenic abscess in a case of mumps. Here we present the case of a 16-year-old girl with unknown vaccination history who presented with fever, rash, bilateral parotid swelling, myocarditis, pneumonitis with pleural effusion and shock. Enzyme-linked immunosorbent assay (ELISA) for mumps Immunoglobulin M (IgM) antibody was positive (ratio: 7.26, reference: 1.10). She was managed conservatively with parenteral antibiotics, oxygen, inotropic support and bronchodilators. As she complained of abdominal pain in the left hypochondrium on the 13th day since onset of symptoms, ultrasound scan of abdomen was done which showed a hypoechoic lesion with internal echoes in the inferior pole of spleen (2.9 cm x 2.2 cm) suggestive of splenic abscess. Computed tomography (CT) of abdomen confirmed similar findings. The splenic abscess completely regressed with parenteral antibiotics. Therefore, one must suspect splenic abscess in a case of mumps when the presentation includes abdominal pain and tenderness so that appropriate treatment may be provided for the best outcome for the patient.

A Case of Acute Parotitis Associated with COVID-19

Coronavirus disease 2019 (COVID-19) emerged in China at the end of 2019 and spread worldwide. A sixty-three-year-old female patient was admitted to the hospital six days after she tested positive for SARS-CoV-2 with complaints of cough, shortness of breath, and myalgia. After seven days, both parotid gland sites developed swelling, tenderness, and pain. The ultrasonography revealed acute parotitis bilaterally. Viral serological tests were negative. Therefore, COVID-19 infection was considered the cause of acute parotitis. The patient was discharged after recovery. This case report emphasized that acute non-suppurative parotitis may develop due to COVID-19 infection as an atypical manifestation.

Neonatal suppurative parotitis: Case reports and literature review

BACKGROUND

Neonatal suppurative parotitis is a rare disease, characterized mainly by unilateral parotid swelling with erythema and tenderness, and often purulent discharge from the Stensen's duct into the oral cavity. Only 44 cases were reported in the English literature between 1970 and 2013.

METHODS

A MEDLINE search was conducted using the terms acute, neonatal, newborn, suppurative, bacterial, purulent, parotitis, parotid swelling, and parotid abscess, limited to the English-language literature starting from 2011. We reviewed all reported cases, together with two more managed cases in our hospital. We also describe the magnetic resonance imaging findings of the early stage of this disease.

RESULTS

We identified 26 new cases since 2011. The total number of patients reviewed was 72, including our patients. The infection was unilateral in 83% of patients, and 67% of the affected patients were males. The serum amylase levels were generally not elevated despite marked parotid swelling. Of the causative agents of this disease, 65% were Staphylococcus aureus, of which 19% were methicillin-resistant S. aureus. As the rate of cesarean section was high in patients with this disease, it was considered a risk factor. The diffusion-weighted magnetic resonance images showed multiple punctate hyperintensity regions with reduced apparent diffusion coefficient, suggesting microabscess formation in the affected gland.

CONCLUSIONS

Acute suppurative parotitis should be considered in cases of swelling and tenderness in the parotid gland during the neonatal period. Multiple punctate hyperintensities in the parotid gland on the diffusion-weighted images may indicate a retrograde bacterial infection from the Stensen's duct.

Differences between radioactive iodine-induced sialadenitis and chronic obstructive parotitis

The purpose of this study was to clarify the differences in the diagnosis and treatment outcomes between radioactive iodine-induced sialadenitis (RAIS) and chronic obstructive parotitis (COP). The study cohort comprised 47 consecutive patients diagnosed with RAIS and 50 patients with COP. All patients were treated by interventional endoscopy. Clinical, sialography, and endoscopy characteristics and treatment outcomes were compared between the two groups. Compared with the COP group, the RAIS group included more females (male:female ratio 1:8.4 vs 1:2.1; P = 0.011) and had a younger onset age (42 vs 50 years; P = 0.001) and shorter disease duration prior to hospital visit (5.4 vs 34.8 months; P < 0.001). In the RAIS group, sialography revealed obliteration of the main duct (20.4% vs 0%; P < 0.001), non-visualization of the main gland (23.7% vs 0%; P < 0.001), and incomplete contrast filling of the main gland (19.4% vs 6.4%; P = 0.008), which were scarcely observed in the COP group. Endoscopy revealed a higher percentage of duct atresia in RAIS compared to COP (20.4% vs 0%; P < 0.001). During follow-up, a higher percentage of RAIS patients had duct atresia and gland atrophy (49.5% vs 1.1%, P < 0.001). Compared with COP, RAIS more commonly involves younger females and has a shorter disease duration. Atresia of the main duct and atrophy of the gland parenchyma occur more often despite the use of interventional endoscopy.

Standardization of terminology, imaging features, and interpretation of CBCT sialography of major salivary glands: a clinical review

Sialography combined with cone beam computerized tomography (sialo-CBCT) is an imaging technique that demonstrates the ductal system of the major salivary glands and allows evaluation of gland function. This review describes the sialo-CBCT technique, terminology, common pitfalls and limitations, as well as radiographic features and suggested pathogenicity of various salivary gland disorders, based on 1,758 sialo-CBCT examinations conducted over the last decade in one institution, and the current literature. The adoption of standardized terminology is proposed to prevent miscommunication, facilitate formulation of differential diagnoses, and thereby promote patient management: (1) Sialo-CBCT requires specific training, and operator experience is required for adequate glandular filling with minimal extravasation; (2) Limit injection-to-scan time to avoid pre-mature emptying; (3) The sialo-CBCT report should include a description of the morphology of the primary duct as well as the secondary, tertiary, and descending branches, the maximal branching level, the presence of sialectasis, overall glandular size, and parenchymal findings; (4) Functional evaluation is based on assessment of iodine clearance in the post evacuation image; (5) Sialectasis and ductopenia are the main findings in Sjogren syndrome and recurrent juvenile parotitis; (6) Sialodochitis with or without fillings defects or hyperdense calcifications characterize obstructive sialadenitis and sialolithiasis; (7) The findings following radioactive-iodine-induced damage are similar to obstructive sialadenitis, with atrophy in late stages; (8) In chronic graft-versus-host disease (cGVHD), variable presentations of ductopenia, sialectasis, and sialodochitis may be evident; (9) The red flags indicating a space-occupying lesion include areas of no filling, splaying of ducts, and primary duct deviation.

The Diagnostic Performance of Early Sjögren's Syndrome Autoantibodies in Juvenile Sjögren's Syndrome: The University of Florida Pediatric Cohort Study

Objectives

The aim of this study was to evaluate the clinical validity of early Sjögren's syndrome (SS) autoantibodies (eSjA), which were originally marketed for early diagnosis of SS, for juvenile SS (JSS) in a recently identified pediatric cohort.

Methods

A total of 105 symptomatic subjects with eSjA results available were evaluated at the Center for Orphaned Autoimmune Disorders at the University of Florida and enrolled for this study. JSS diagnosis was based on the 2016 ACR/EULAR SS criteria. Demographic/clinical/laboratory parameters were compared between JSS (n = 27) and non-JSS (n = 78) for % positivity, sensitivity, and specificity of eSjA (SP1, anti-salivary protein; CA6, anti-carbonic anhydrase VI; PSP, anti-parotid secretory protein) and classic SS-autoantibodies (cSjA; ANA, SSA/SSB, RF, and others) either alone or in combination. Associations between eSjA and diagnostic/glandular parameters were also determined by Fisher's exact test.

Results

Compared to non-JSS, JSS patients exhibited sicca symptoms demonstrating reduced unstimulated salivary flow rate (USFR) and abnormal glandular features revealed by salivary gland ultrasound (SGUS). Among cSjA, ANA demonstrated the highest sensitivity of 69.2%, while SSA, SSB, and RF showed around 95% specificities for JSS diagnosis. The % positive-SSA was notably higher in JSS than non-JSS (56% vs. 5%). Of eSjA, anti-CA6 IgG was the most prevalent without differentiating JSS (37%) from non-JSS (32%). Sensitivity and specificity of eSjA were 55.6 and 26.9%, respectively. Autoantibodies with potentially applicable specificity/sensitivity for JSS were seen only in cSjA without a single eSjA included. There were no associations detected between eSjA and focus score (FS), USFR, SSA, SGUS, and parotitis/glandular swelling analyzed in the entire cohort, JSS, and non-JSS. However, a negative association between anti-PSP and parotitis/glandular swelling was found in a small group of positive-SSA (n = 19, p = 0.02) whereas no such association was found between anti-PSP-positive compared to anti-PSP-negative. JSS and non-JSS groups differed in FS, USFR, and EULAR SS Patient Reported Index Dryness/Mean in CA6/PSP/ANA, SP1, and SSA-positive groups, respectively. Additionally, a higher FS was found in RF-positive than RF-negative individuals.

Conclusions

eSjA underperformed cSjS in differentiating JSS from non-JSS. The discovery of clinical impact of eSjA on early diagnosis of JSS necessitates a longitudinal study.

Postoperative Acute Parotitis After Cesarean Delivery Under Spinal Anaesthesia

Postoperative acute painless parotid gland swelling, which is a rare complication has been reported after caesarian section (CS) under neuraxial anaesthesia. Hereby, we aimed to present a parturient suffering from acute parotitis complication for her elective CS under spinal anaesthesia who had a previous history of acute parotitis after epidural anaesthesia.

Atypical Kawasaki Disease Complicated With Coronary Artery Aneurysm: A Case Report and Review of Literature

Background: Kawasaki disease (KD) is an acute, febrile systemic vasculitis of early childhood. A small group of KD patients does not meet the classical presentation of KD, termed incomplete KD. Incomplete or atypical KD patients are usually infants and older children. Because of atypical manifestations of KD, timely diagnosis of KD is difficult, which leads to coronary artery complication

Case presentation: We report the case of a nine-year-old boy who developed fever and right side parotitis with painful cervical lymphadenopathy leading to torticollis as the first symptom of Kawasaki disease (KD). A series of investigations revealed elevated inflammatory markers and aneurysmal dilation of coronary artery on echocardiogram, and thus he was diagnosed with atypical KD. Intravenous immunoglobulin was given and the child responded well. Coronary artery aneurysm resolved by six months.

Conclusion: A high index of suspicion should be maintained in children presenting with fever and unusual manifestations like lymphadenopathy and parotitis, especially where empiric antibiotics were ineffective. Evaluation of cardiac function and coronary artery status with echocardiography is helpful in defining the diagnosis of KD in such cases. As it is a noninvasive test, it should be undertaken at the first possible clinical suspicion.

[A complex approach to the differential diagnosis of chronic parenchymal parotitis in children]

BACKGROUND

Chronic parenchymal parotitis is the most common salivary gland disease in children which occurs in about 85% cases. Diagnosis errors in chronic parenchymal parotitis are frequent and important but represent an underemphasized and understudied area of patient safety.

OBJECTIVE

The objective of this study was to elaborate the most effective and acceptable strategies for the diagnosis of chronic parenchymal parotitis in children.

MATERIAL AND METHODS

We studied the histories of 211 patients with a primary diagnosis of chronic parenchymal parotitis. All patients underwent ultrasound diagnostic, as well as medical and genetic counseling and examination of 1st degree relatives and probands.

RESULTS

After additional examinations, 100 children were given other diagnoses. Having analyzed the results of medical-genetic and echographic examinations of 111 patients with chronic parenchymal parotitis and their family members, we have developed a pattern of chronic parenchymal parotitis inheritance. All patients were divided into 3 groups according to the type of inheritance: monogenic inheritance, multifactorial inheritance, and sporadic cases.

CONCLUSION

A complex approach to the differential diagnosis of chronic parenchymal parotitis is what is needed to reduce the frequency of diagnostic errors.

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.

Upward Trends of Parotitis and Mumps in Atlanta over a Decade

Rising rates of mumps in Georgia have been reported. We hypothesize that the incidence of parotitis and mumps presenting to Children’s Healthcare of Atlanta (CHOA) has increased over the past decade among immunized children. Retrospective chart reviews were conducted using ICD9/10-codes for parotitis and mumps from January 2007 to December 2017. Data on demographics, vaccination status, labs, management and disposition were collected. 1017 parotitis cases were diagnosed; an upward trend in incidence occurred over time. Mumps testing was done in 47 (4.6%) parotitis cases; 9 mumps cases were identified, with 6 diagnosed in 2017. Seven patients (78%) were fully vaccinated. Median age for mumps was 13 years. Few symptoms differentiate mumps from non-mumps-parotitis. The incidence of parotitis and mumps in children has increased since 2007 in the Atlanta area, reflecting a nationwide trend. Mumps is likely underreported as rates of testing are low, and should be considered in children with parotitis regardless of vaccination history.

[Investigation of active components and mechanism of Pudilan Xiaoyan Oral Liquid based on network pharmacology]

To investigate the active components/ingredients of Pudilan Xiaoyan Oral Liquid based on the network pharmacology technology, and analyze the network data of its potential targets and mechanisms. The active ingredient screening, protein interaction analysis and pathway annotation were used to further optimize its active components and potential targets, and clarify the pharmacodynamic substance basis and mechanism of Pudilan Xiaoyan Oral Liquid. Through this technique, we screened out 41 active ingredients in Pudilan Xiaoyan Oral Liquid, mainly including 16 alkaloid components, 13 organic acid components, 11 flavonoid components and 1 coumarin component such as chicoric acid, chlorogenic acid, oroxindin, rutin, corynoline, and esculetin. In addition, 6 targets for parotitis, 48 targets for tonsillitis, and 22 targets for pharyngitis were screened. A total of 22 disease signaling pathways are involved, including 4 pathways closely related to inflammation. The IL-17 signaling pathway had the highest D(degree) value and may be most closely related to inflammatory diseases. Through network data excavating, we initially explored the main active components/ingredients of Pudilan Xiaoyan Oral Liquid, clarified the pharmacodynamic basis of Pudilan Xiaoyan Oral Liquid treatment-related diseases and its key mechanism of action in this study, hoping to provide a theoretical basis for clinical research, and at the same time, lay the foundation for deep research and promotion of Pudilan Xiaoyan Oral Liquid product.

Incidence and risk factors for radioactive iodine-induced sialadenitis

BACKGROUND

Radioactive iodine (¹³¹I) is one of the treatments of hyperthyroidism and differentiated thyroid carcinoma (DTC). Swelling of salivary glands are one of the possible side effects of this treatment, known as radioactive iodine-induced sialadenitis (RAIS). The prevalence of RAIS varies widely and no specific risk ratio has been established.

OBJECTIVES

To determine the incidence of RAIS, analysing the epidemiological data and tumour- and treatment-related factors that may influence the development of the disease.

MATERIAL AND METHODS

197 patients who received radioiodine treatment between 2015 and 2017 were studied (76.6% women). The variables studied were age, gender, weight, height, and body mass index; presence of high blood pressure, dyslipidemia, diabetes, and thyroid diseases; cumulative radioiodine dose, presence of sialadenitis, affected salivary gland, and the time of onset.

RESULTS

14 patients developed sialadenitis (78.6% women), all with DTC. The incidence of sialadenitis was 3.4% overall and 6.3% among DTC patients. Furthermore, we found that higher cumulative radioiodine doses confer a greater risk of developing sialadenitis, with a hazard ratio of 1.009 (p = .001). No association was found between the epidemiologic data studied and sialadenitis.

CONCLUSIONS

In this series, a dose-dependent relationship was found between radioiodine treatment and sialadenitis.

Sialadenitis: A Possible Early Manifestation of COVID-19

Acute sialadenitis may be caused by viruses, including coronaviruses. Although there are anecdotal reports of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) salivary gland infections, there have been no well‐documented cases of sialadenitis in patients with COVID‐19 described in the literature. We report a case of parotitis and submandibular gland sialadenitis, as well as an isolated case of parotitis, in two patients with concurrent SARS‐CoV‐2 infections. Computed tomography imaging demonstrated parotid and submandibular gland enlargement with heterogenous enhancement and attenuation, consistent with sialadenitis. Medical management was sufficient for successful resolution of the acute sialadenitis. Laryngoscope, 130:2595–2597, 2020

L-asparaginase-induced Parotitis in an Elderly Patient with Acute Lymphoblastic Leukemia

A 67-year-old woman received induction chemotherapy comprising vincristine, daunorubicin, cyclophosphamide, L-asparaginase and prednisolone for acute lymphoblastic leukemia with a common B-cell phenotype. The administration of L-asparaginase at 3,000 U/m² for 6 days was planned. Before the fourth administration on day 16, left parotid swelling was identified along with increased serum amylase (991 U/L; 94% derived from salivary glands). An enlarged left parotid gland was apparent on computed tomography. The symptoms resolved after cessation of L-asparaginase, with serum amylase normalizing by day 20. This rare adverse event should be recognized as improving within a week after ceasing L-asparaginase.

[Sialendoscopy in diagnosis and treatment of salivary gland disorders]

Sialendoscopy is a relatively new and progressive procedure that allows endoscopic transluminal visualization of major salivary glands and offers a mechanism for diagnosing and treatment of both inflammatory and obstructive pathology related to the ductal system. Several authors have stressed the striking role of sialendoscopy in prevention of juvenile recurrent parotitis. However, the emerging use of sialendoscopy in juvenile recurrent parotitis has not been critically analysed. The objective of our review is to overview the existing literature with particular regards to diagnostic and therapeutic outcomes after the application of sialendoscopy.

Parotitis due to Burkholderia cepacia infection after autologous hematopoietic stem cell transplantation

Burkholderia cepacia predominantly causes opportunistic infections in hospitalized and immunocompromised patients such as patients with cystic fibrosis, cancer, or human immunodeficiency virus (HIV). Nonetheless, Burkholderia cepacia is infrequently reported to cause infection in hematopoietic stem cell transplantation (HSCT) recipients. Herein, we report a rare case of suppurative parotitis in a 31-year-old patient with T-cell lymphoblastic lymphoma (T-LBL) who underwent auto-HSCT. The secretion from the Stensen duct was collected, and Burkholderia cepacia was detected using the VITEK-2 identification system. Additionally, sensitive antibiotic therapy against this bacterium was also effective. This is the first case of parotitis triggered by Burkholderia cepacia after auto-HSCT, and it is also the first reported domestic case. This case emphasizes the importance of considering bacterial infections in general and Burkholderia cepacia specifically in HSCT patients with post-transplant parotitis.

Parotitis-Like Symptoms Associated with COVID-19, France, March-April 2020

We report the clinical features of 3 patients in France who had parotitis (inflammation of the parotid salivary glands) as a clinical manifestation of confirmed coronavirus disease. Results from magnetic resonance imaging support the occurrence of intraparotid lymphadenitis, leading to a parotitis-like clinical picture.

Pneumoparotid and Pneumoparotitis: A Literary Review

Pneumoparotid is a rare condition of parotid swelling. The presence of the air in gland parenchyma is caused by an incompetent Stensen’s duct with high pressure may cause the acini’s rupture. We reviewed 49 manuscripts, from 1987 to today, that enrolled a total of 54 patients with pneumoparotid. Our review evaluated the following evaluation parameters: gender, age, etiology, clinical presentation, treatment, days of resolution after diagnosis, relapse and complications. The most frequent etiology is self-induction by swelling the cheeks (53.7%). This cause mainly involves children (74%), for conflicts with parents, excuses for not going to school, nervous tics or adults (16%) with psychiatric disorders. Iatrogenic causes are also frequent (16.6%), for dental treatments (55.5%) or use of continuous positive airway pressure (CPAP) (33.4%). Medical therapy is the most practiced (53.7%), in most cases it is combined with behavioral therapy (25.9%) or psychotherapy (25.9%). Surgery is rarely used (9.2%) as a definitive solution through parotidectomy (50%) or ligation of the duct (50%). The most common complication is subcutaneous emphysema (24.1%), sometimes associated with pneumomediastinum (5.5%). Careful treatment and management are necessary to ensure the resolution of the pathology and counteract the onset of complications.

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Introduction  Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections.

Objective  To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years.

Methods  A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016.

Results  Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolaryngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties – resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improvements in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis.

Conclusions  Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unnecessarily long period of suffering despite a favorable outcome following the correct treatment.

Periapical abscess progressing to parotitis and descending necrotizing mediastinitis with thoracic abscess in a patient on etanercept: A case report

Patients on Type 2 biologics, such as etanercept, are at increased risk for aggressive infections. This may be further exacerbated by concomitant systemic corticosteroid use or comorbidities such as diabetes. We report a case of a patient with rheumatoid arthritis on etanercept with poor dentition and periodontal disease, who developed parotitis with peritonsillar abscess and descending necrotizing mediastinitis (DNM) with periaortic abscess arising from a periapical abscess. Morbidity and mortality of such infections is high. A multimodal assessment and treatment team is required to optimize patient survival and outcomes. This manuscript discusses the diagnostic and treatment challenges of DNM of immunocompromised patients.

A 13-Year-Old Boy Who Has Kawasaki Disease Shock Syndrome Presents with Parotitis

We report a 13-year-old boy who (initially) had symptoms of toxic shock-like syndrome and mumps. Then, the patient was hospitalized in the pediatric intensive care unit (PICU) because of his ongoing hemodynamic instability (low blood pressure of 70/30 mm Hg and capillary refill time of > 4 seconds). During his stay in the PICU, the patient was treated with fluid resuscitation and vasoactive infusion and at the same time was diagnosed with Kawasaki disease shock syndrome (KDSS), when giant right coronary artery aneurysms were detected on echocardiographic examination. This case illustrates the risk of KDSS in patient who carries both parotitis and toxic shock-like syndrome. The clinicians should be cautious about detecting any types of coronary artery aneurysms in such patients. This is the first case of KDSS associated with parotitis reported in the literature.

Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign-Iowa, July 2015-May 2016

Background

In response to a mumps outbreak at the University of Iowa and surrounding community, university, state, and local health officials implemented a vaccination campaign targeting students <25 years of age with an additional dose of measles-mumps-rubella (MMR) vaccine. More than 4700 vaccine campaign doses were administered; 97% were documented third doses. We describe the epidemiology of the outbreak before and after the campaign, focusing on cases in university students.

Methods

Mumps cases were identified from reportable disease databases and university health system records. Detailed information on student cases was obtained from interviews, medical chart abstractions, university and state vaccination records, and state public health laboratory results. Pre- and postcampaign incidence among students, university faculty/staff, and community members <25 vs ≥25 years old were compared using Fisher exact test. Multivariable regression modeling was performed to identify variables associated with a positive mumps polymerase chain reaction test.

Results

Of 453 cases in the county, 301 (66%) occurred in university students. Student cases were primarily undergraduates (90%) and highly vaccinated (86% had 2 MMR doses, and 12% had 3 MMR doses). Fewer cases occurred in students after the campaign (75 [25%]) than before (226 [75%]). Cases in the target group (students <25 years of age) declined 9% postcampaign (P=.01). A positive mumps polymerase chain reaction test was associated with the presence of parotitis and early sample collection, and inversely associated with recent receipt of MMR vaccine.

Conclusions

Following a large additional dose MMR vaccination campaign, fewer mumps cases occurred overall and in the target population.

A case of Kawasaki disease presenting with parotitis: A case report and literature review

RATIONALE

Kawasaki disease affects multiple organ systems. Its typical symptoms include fever, rash, oropharyngeal mucosal erythema, bilateral non-exudative conjunctivitis, cervical lymphadenopathy, extremity changes, and membranous desquamation of the fingers and toes. In severe cases, cardiovascular, respiratory, musculoskeletal, gastrointestinal, neurological, and genitourinary complications may occur. In the early stage, Kawasaki disease is often manifested by uncommon symptoms, such as pyuria, meningitis, shock, and retropharyngeal or parapharyngeal abscess, which may delay diagnosis and treatment. We have reported a case of Kawasaki disease presenting with mumps and reviewed the clinical features of 14 other similar cases, in order to facilitate the early diagnosis and treatment of this unusual presentation of Kawasaki disease.

PATIENT CONCERNS

A 10-year-old boy presented with persistent fever and parotitis and was diagnosed with suppurative parotitis. After antibiotic therapy, the parotid swelling reduced, but the fever persisted and other typical symptoms of Kawasaki disease appeared, including bilateral conjunctival hyperaemia, cervical lymphadenopathy, oropharyngeal mucosal erythema, membranous desquamation of the fingers, and left coronary artery widening.

DIAGNOSES

The patient was diagnosed with Kawasaki disease 12 days after the onset of fever.

INTERVENTIONS

The patient was administered γ-globulin 1.0 g/kg·d for 2 consecutive days and oral aspirin 5 mg/kg·d.

OUTCOMES

The left coronary artery returned to a width of 3.8 mm after 1 month and of 3.1 mm after 3 months. The dose of aspirin was reduced to 3 mg/kg·d after 2 months and to 1.5 mg/kg·d after 3 months.

LESSONS

Physicians should be aware that Kawasaki disease may develop after parotitis.

[Mumps virus: a comprehensive review]

Once very common in children, mumps virus infection is now much rarer thanks to vaccination, recommended in the majority of countries in the world. This virus of the family Paramyxoviridae has a marked tropism for glandular tissues which explains the great diversity of pathologies related to this virus, including parotitis, orchitis or meningitis. Due to the lower circulation of the virus, the proportion of infected adults increases. A surveillance system for mumps virus infections at the national and international levels is organized, particularly at the molecular level. In France, it is provided by the national reference center for Measles, Mumps and Rubella. Although it has led to a significant reduction in the number of cases, the long-term effectiveness of mumps vaccination is questionable. The nature of the vaccine strains and the lack of regular stimulation of populations by circulating wild viruses may explain, in part, the decrease in immunity over time. Thus, the vaccination recommandations could evolve in the future to reach eradication in a medium or long term.

Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States

Background

During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza.

Methods

During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed.

Results

Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases.

Conclusions

Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season.

Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States

Background

During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence.

Methods

NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B.

Results

Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses.

Conclusions

Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.

Pediatric Primary Tuberculous Osteomyelitis of the Mandible Mimicking Parotitis

Tuberculosis (TB) is a worldwide public health problem; however, primary tuberculous osteomyelitis involving the mandible is extremely rare. Here, we report a 14-year-old boy who presented with a recurrent, generalized swelling of the cheek in the right side, mimicking parotitis. Fine needle aspiration cytology (FNAC) from the swelling was inconclusive. Contrast-enhanced computed tomography (CECT) of the head and neck revealed an osteolytic lesion of the mandible with a surrounding abscess. An intraoral incisional biopsy of the tissue showed a granulomatous lesion. The patient was started on anti-tubercular therapy (ATT) for six months. Our patient's presentation underscores the clinical difficulty in establishing a diagnosis and considering tuberculous osteomyelitis in the differential diagnosis.

Typical Kawasaki Disease Presenting With Pancreatitis and Bilateral Parotid Gland Involvement: A Case Report and Literature Review

We describe the case of a 3-year child in which pancreatic and parotid gland involvement preceded the development of the classical clinical phenotype of a typical Kawasaki disease (KD). The child was referred to the Emergency Department with a story of 3 days of continuous fever associated with abdominal pain and bilaterally swelling in the parotid regions; laboratory evaluation identified markedly increased levels of total amylase, pancreatic amylase, lipase, and transaminase, and diagnosis of pancreatitis was posed. After 9 days of fever and persistence of the clinical features, the classical signs of KD appeared, and the child was treated with intravenous immunoglobulins (IVIG), showing a dramatic response with complete resolution of the clinical picture. In this work, we reviewed the literature about gastrointestinal (GI) symptoms in KD, focusing on pancreatic and hepatic involvement. This analysis highlighted that, in case of fever associated with pancreatic inflammation, KD must be considered in the spectrum of differential diagnosis, and that GI involvement in KD is frequently associated with an incomplete response to IVIG treatment.

Pneumoparotitis as a complication of long-term oronasal positive airway pressure for sleep apnea

BACKGROUND

Parotid swelling is rarely caused by pneumoparotitis from retrograde insufflation of air into Stensen's duct. Previous reports have identified occupational exposures, self-induced habits, exercise, spirometry, and short-term positive pressure airway ventilation as causes of salivary duct insufflation.

METHODS

We present 2 cases of pneumoparotitis in patients on long-term oronasal continuous positive airway pressure (CPAP) for obstructive sleep apnea.

RESULTS

A diagnosis of pneumoparotitis was made by CT scan in case 1 and sialography in case 2. Patients were advised to transition from oronasal to nasal-only CPAP. One patient was successfully transferred and had good symptomatic improvement, whereas the second patient did not tolerate nasal CPAP and had persistent symptoms on oronasal CPAP.

CONCLUSION

Long-term use of oronasal CPAP is a potential cause of pneumoparotitis.

Facial and limb angioedema with parotitis and Kikuchi-like necrotizing lymphadenitis preceding neuropsychiatric systemic lupus erythematosus in a young African American male

Angioedema has been observed in a few cases secondary to systemic lupus erythematosus (SLE). Herein, we report a rare case where a young healthy male initially presented with angioedema, lymphadenopathy and parotitis and later on developed neuropsychiatric manifestations at the very onset of his SLE disease. This case illustrates the importance of prompt clinical consideration of lupus with unusual and atypical preceding manifestations.

Sialoendoscopy combined with an internal stent and postoperative massage as a comprehensive treatment of delayed I131-induced parotitis

A common complication of radioiodine (I¹³¹) treatment of thyroid cancer is parotitis. Here we describe our clinical experience in treating delayed I¹³¹-induced parotitis using sialoendoscopy together with an internal stent and postoperative massage. In this retrospective cohort study we reviewed 32 patients who were treated in that way under general anaesthesia between July 2010 and March 2015. Their age, sex, and the time to development of the parotitis were collected from the hospital's database. All patients were evaluated using a visual analogue scale (VAS), sialography, and computed tomography preoperatively. The analyses of VAS scores were made during postoperative follow-up visits. We used the paired Student's t test and one-way ANOVA to assess the significance of differences, and probabilities of < 0.05 were accepted as significant. The mean (SD) age of the 32 patients was 50 (11) years, and they developed symptoms of delayed parotitis after a mean (SD) of 12 (11) months. The mean time between treatment with I¹³¹ and sialoendoscopy was 26 (10) months. Ductal stenosis was the most common sialoendoscopic feature, together with mucous plugs and fibrosis. Fifty of the 56 ducts were successfully dilated by sialoendoscopy, and VAS scores significantly decreased from a preoperative 7.3 (1.1) to a postoperative 3.3 (2.1) (p=0.000) during follow-up of 3 - 41 months. Sialoendoscopic interventions combined with an internal stent and postoperative massage may be optimal comprehensive treatment for delayed I¹³¹-induced parotitis.

Mumps Outbreak Among a Highly Vaccinated University Community-New York City, January-April 2014

Background

On 14 January 2014, a vaccinated student presented with parotitis. Mumps immunoglobulin M (IgM) testing was negative and reverse-transcription polymerase chain reaction (RT-PCR) testing was not performed, resulting in a missed diagnosis and the start of an outbreak at a New York City (NYC) university.

Methods

Mumps case investigations included patient interviews, medical records review, and laboratory testing including mumps serology and RT-PCR. Case patients were considered linked to the outbreak if they attended or had epidemiologic linkage to the university. Epidemiologic, clinical, and laboratory data for outbreak cases residing in NYC were analyzed.

Results

Fifty-six NYC residents with mumps were identified with onset between 12 January and 30 April 2014. Fifty-three cases (95%) were university students, 1 (2%) was a staff member, and 2 (4%) had epidemiologic links to the university. The median age was 20 years (range 18-37 years). All cases had parotitis. Three cases were hospitalized, including 1 of 2 cases with orchitis. Fifty-four (96%) cases had received ≥1 mumps-containing vaccine, 1 (2%) was unvaccinated due to religious exemption, and 1 (2%) had unknown vaccination status. Two of the 44 (5%) cases tested by serology were mumps IgM positive, and 27 of the 40 (68%) tested by RT-PCR were positive.

Conclusions

Mumps outbreaks can occur in highly vaccinated populations. Mumps should be considered in patients with parotitis regardless of vaccination status. RT-PCR is the preferred testing method; providers should not rely on IgM testing alone. High vaccination coverage and control measures likely limited the extent of the outbreak.

Streptococcus pneumoniae bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren's syndrome

Introduction:

Invasive pneumococcal disease is an uncommon and notifiable disease in Singapore. It is often associated with significant morbidity and mortality. We report a rare case of invasive pneumococcal bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren’s syndrome. We also present a retrospective review of Streptococcus pneumoniae bacteraemia cases in Singapore General Hospital from January 2011 to April 2016.

Case presentation:

A 59-year-old Malay lady with a history of systemic sclerosis with secondary Sjögren’s syndrome presented with fever and left parotid gland swelling. Clinical examination revealed poor salivary pooling and left parotid swelling without fluctuance. Ultrasound of the left parotid gland confirmed acute parotitis without evidence of abscess or sialolithiasis. Blood cultures were positive for S. pneumoniae. She was diagnosed to have invasive pneumococcal bacteraemia secondary to acute parotitis, and treated with intravenous benzylpenicillin with clearance of bacteraemia after 3 days. Upon discharge, her antibiotics were changed to intravenous ceftriaxone to facilitate outpatient parenteral antibiotic therapy for another 2 weeks. She responded favourably to antibiotics at follow-up, with no complications from the bacteraemia. A review of the microbiological records of the Singapore General Hospital revealed 116 cases of pneumococcal bacteraemia, most (80.3 %) of which were due to pneumonia. None were due to parotitis.

Conclusion:

S. pneumoniae parotitis and subsequent bacteraemia is rare. Prompt recognition of the disease and appropriate use of antibiotics are important. This case highlights that close communication between healthcare workers (microbiologist, rheumatologist and infectious disease specialist) is essential in ensuring good clinical outcomes in patients with a potentially fatal disease.

Sialendoscopy for non-stone disorders: The current evidence

OBJECTIVE

Review the current literature on the use of sialendoscopy in the treatment of non-stone disorders of the major salivary glands.

DATA SOURCES

Eligible articles that reported on the use of sialendoscopy in the treatment of non-stone disorders were identified using MEDLINE, Embase, and Google Scholar through May 2016. The search used key words sialendoscopy, salivary endoscopy, salivary scope, salivary duct stenosis, salivary duct stricture, Sjogren's disease, radioiodine sialadenitis, salivary duct obstruction, sialadenitis, chronic sialadenitis, juvenile recurrent parotitis, parotitis, and radiation sialadenitis.

REVIEW METHODS

Full-length prospective and retrospective original articles; systemic reviews; and meta-analysis, including adults and children with adequate data for evaluating the sialendoscopy for non-stone disorders, were included. Individual case reports were excluded.

RESULTS

There is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non-stone disorders worldwide. The studies of sialendoscopy for non-stone disorders are often retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjögren syndrome, respectively.

CONCLUSION

Although the initial evidence for the use of sialendoscopy for non-stone disorders is not as established as that for stones, it remains a promising gland-preserving tool in the management of non-stone disorders of major salivary glands.

Mumps virus pathogenesis: Insights and knowledge gaps

The recent mumps outbreaks among MMR vaccinated persons have raised questions about the biological mechanisms related to mumps symptoms and complications in the background of waning immunity. Contrary to other paramyxoviruses, the understanding of mumps virus pathogenesis is limited, and further in-depth clinical studies are required to provide answers to important research questions.

Evaluation and management of juvenile recurrent parotitis in children from northern Greece

BACKGROUND

Juvenile Recurrent Parotitis (JRP) is a recurrent parotid inflammation of childhood.  The aim of our study was to investigate the clinical, laboratory and imaging profile of children with JRP as well as to estimate the impact of siadendoscopy as a therapeutic tool in the clinical outcome of JRP.

METHODS

Twenty-three children with JRP aged 3.5-16 years, were investigated. Twelve of them underwent sialendoscopy: seven aged <8 years under general and five aged >8 years under local anesthesia.

RESULTS

The age at onset ranged from 2-15 years while the number of episodes from 2-8 per year. The autoantibody profile was negative in all patients, suggesting no evidence for autoimmune diseases.  Antibody deficiency was found in two children. The imaging studies reveal an overall parotid swelling and intraparotid lymph nodes while microabscesses were present in 31% of the patients. Twelve patients who underwent sialendoscopy had a significant improvement in their clinical outcome; the mean episodes of JRP before sialendoscopy was 3.9/year and reduced to 0.4 at the post-intervention year.

CONCLUSION

Sialendoscopy represents an alternative and promising perspective in the management of JRP. Hippokratia 2015; 19 (4): 356-359.

Viral etiology of mumps-like illnesses in suspected mumps cases reported in Catalonia, Spain

We investigated the etiology of reported sporadic suspected mumps cases with a negative RT-PCR result for the mumps virus in the Barcelona-South region in 2007-2011. Samples from mumps virus-negative patients presenting unilateral or bilateral parotitis or other salivary gland swelling were tested for Epstein-Barr virus (EBV) by real-time PCR and for respiratory viruses by two multiplex-PCR-based assays to detect parainfluenza virus (PIV) 1-4, influenza virus (InV) A, B and C, respiratory syncytial virus (RSV), enterovirus, coronavirus 229E, coronavirus OC43, and rhinovirus. 101 samples were analyzed in persons aged 8 months to 50 years. Oral samples were collected on the first day of glandular swelling in 53 patients (52.5%), and on the first two days in 74 patients (73.3%). Viruses were detected in 52 (51.5%) of samples: one virus (25 EBV, 8 PIV3, 4 adenovirus, 4 PIV2, 1 PIV1, 1 InVA, and 1 enterovirus) was detected in 44 patients (84.6%), two viruses in 7 patients, and three viruses in one patient. In 58 patients (57.5%) whose sample was collected in the first 2 days after onset of parotitis and had received two doses of MMR vaccine and in 15 patients (14.8%) whose sample was collected on the first day, it is very likely that the cause was not the mumps virus. This would mean that 72.3% (73/101) of the reported sporadic suspected mumps cases were not mumps cases. The timing of oral-sample collection is crucial to correctly interpret the negative results for mumps virus RNA, especially when suspected cases occur in vaccinated persons.

Suppurative parotitis and submandibular sialadenitis

Suppurative involvement of salivary gland in neonates is a rare disorder. Parotid gland being the most commonly involved. We described a case of suppurative parotitis leading to abscess formation and subsequent involvement of the submandibular gland. Incision and drainage of the abscess was performed, most of the purulent material was drained. Symptoms and signs resolved within 2 days. Pus culture grew Staphylococcus aureus.

Neonatal parotid gland enlargement: Is it suppurative parotitis? A case report

Background:

Acute suppurative parotitis (ASP) is a rare finding in the neonate. It is commonly caused by S. aureus but other bacterial isolates may be emerging. Effective treatment includes prompt diagnosis, parenteral antibiotics and supportive measures such as rehydration and bimanual gland massage.

Case Report:

This case report describes an extremely premature female infant with a complicated post-natal course who presented with unilateral swelling of the parotid region. Diagnostic workup revealed purulent exudate from Stensen’s duct and ultrasound findings consistent with parotitis. Culture of the exudate showed growth of Staphylococcus aureus and Enterococcus species. The patient responded well to a ten-day antibiotic course and supportive measures.

Conclusions:

ASP, though rare, should be considered in the differential diagnosis of a neonatal parotid swelling since early and prompt diagnosis prevents morbidity and complications.

Facial nerve paralysis: a rare complication of parotid abscess

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.