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.

Mumps is an acute, contagious, systemic viral disease, usually causing painful enlargement of the salivary glands, most commonly the parotids

  • 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 an associated orchitis.
  • All cases are reported promptly to public health authorities.

Other viral causes of parotitis – Viral infections 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.

Diagnosis is clinical

  • Laboratory confirmation of mumps may be achieved with IgM antibody, IgG antibody titer, PCR, or culture

Mumps is self-limiting treat with hydration and rest

  • Vaccination is effective for prevention

parotitis

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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Sialadenitis (Lecture) (Prev Lesson)
(Next Lesson) Oropharyngeal trauma
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