Question

9 year-old boy with sudden onset of unilateral facial swelling. What’s the diagnosis?

Answer

Answer: Acute Parotitis

• Viral parotitis
  • Usually bilateral swelling without warmth or erythema; typically a benign course
  • 85% of cases occur in children <15 years old
  • Common causes: Influenza, Para-influenza, and Coxsackie; Rarely Paromyxovirus (Mumps) due to vaccination programs
  • Treat conservatively; sialagogues to stimulate gland drainage (lemon drops or orange juice), warm compresses, or local massage.
• Bacterial parotitis
  • Commonly presents with unilateral pain, induration, erythema, and tenderness; 20-50% mortality!
  • Risk factors: chronic illness, age > 60, recent surgery, and dehydration
  • Treatment: Antibiotics (covering oral flora) and certain cases may require surgical intervention
  • Lack of improvement within 48 hours requires CT scan to exclude abscess and IV antibiotics

Bonus Trivia: U.S. President Garfield died from parotitis after becoming dehydrated following abdominal surgery

Shelly J. McQuone MD, Acute Viral and Bacterial Infections of the Salivary Glands, Otolaryngologic Clinics of North America, Volume 32, Issue 5 (October 1999)

References

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