PANCE Blueprint EENT (7%)

Parotitis (ReelDx)

VIDEO-CASE-PRESENTATION-REEL-DX

Parotitis - Mumps

3-year-old with left-sided facial edema (watch video)

Patient will present as → an 11-year-old boy with malaise and swelling of his face.  He has no significant past medical history, but it is documented in his chart that his mother declined the recommended standard immunizations for children because of personal beliefs. Vital signs are stable with the exception of a mild fever. In addition to the facial swelling, physical exam is also notable for swelling around the testes. There are no rashes.

Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans

  • Patients present with fever and chills, periauricular, mandibular pain, and swelling; trismus, dysphagia; purulent drainage
  • Viral ⇒ No discharge, prodrome followed by swelling lasting 5–10 days

Causes of parotitis:

  • Dehydration is a common, non-infectious cause of parotitis. It may occur in elderly or after surgery
  • Infectious parotitis 
    • Bacterial parotitis: is most often caused by a bacterial infection of Staphylococcus aureus.
    • Viral parotitis
      • Mumps is the most common viral cause of parotitis is mumps
          • Caused by the paramyxovirus. Likely in a child without complete vaccination series
          • Typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by parotitis; the illness is usually self-limited
          • In adult males look for associated orchitis
          • All cases are reported promptly to public health authorities.
      • Other viral causes associated with parotitis include influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-Barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus
  • Autoimmune parotitis:
    • Sjögren's syndrome: The syndrome is often characterized by excessive dryness in the eyes, mouth, nose, vagina, and skin
    • Sarcoidosis as part of Mikulicz syndrome
  • Sialolithiasis, or salivary duct calculus - blockage of the main parotid duct, or one of its branches, is often a primary cause of acute parotitis
"Bulimia nervosa is associated with parotitis, enamel erosion, electrolyte disturbances, metabolic alkalosis, and dorsal hand calluses from induced vomiting also known as Russell sign."

Diagnosis is often clinical

  • Sample purulent exudate, ultrasound-guided needle aspiration; culture, Gram stain
  • Ultrasound ⇒ increased blood flow through gland, enlargement, nodules
  • CT scan ⇒ extension of inflammation to surrounding tissue
  • Complete blood count (CBC)
  • Serum and urinary amylase rise during the first week of parotitis without underlying pancreatitis
  • Viral shows leukocytosis, increased IgM against mumps

Treatment is based on the lab investigation report

  • Hydration; IV antibiotics

Mumps is self-limiting treat with hydration and rest

  • Vaccination is effective for prevention
  • Contagious for 9 days after onset of parotid swelling

Question 1
A 10-year-old boy presents to the office, complaining of a painful, swollen area along his right jaw and neck. On physical examination, he is noted to be febrile and has diffuse tenderness over the right parotid gland. His laboratory tests include an elevated serum amylase. His parents elected not to vaccinate him. In this patient, based on the most likely diagnosis, which of the following is a complication of his disease?
A
hepatitis
B
nerve deafness
C
pneumonitis
D
testicular torsion
Question 1 Explanation: 
The most likely diagnosis in this patient is mumps. It is endemic in most unvaccinated populations. The onset is characterized by pain and swelling in one or both parotid glands. The pain can be exacerbated by tasting sour liquids such as lemon juice. An elevated serum amylase level is common and coincides with the parotid swelling. Unilateral, rarely bilateral, nerve deafness is a complication of mumps that may be transient or permanent. Other complications include meningoencephalomyelitis, orchitis, epididymitis, pancreatitis, arthritis, and rarely thyroiditis and myocarditis.
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