Acute Suppurative Parotitis: Uncommon Presentation in a Premature Infant

Abstract

A 1260-gm infant boy was born to a 14-year-old gravida 1, para 1 mother at 27 weeks' gestation after an uneventful pregnancy, labor, and a normal spontaneous vaginal delivery. Apgar scores were 3 and 6 at 1 and 5 minutes, respectively. His early neonatal course included mild hyaline membrane disease requiring oxygen and nasal continuous positive airway pressure and hyperbilirubinemia secondary to Rh incompatibility that was treated with phototherapy. He also developed a right upper lobe pneumonia treated successfully with antibiotics. The blood cultures were sterile and the pneumonia resolved rapidly. He remained stable and feedings were initiated gradually.By the end of his 33rd postconceptional week, the child was stable in room air, receiving theophylline for apnea of prematurity, and on full feeds through a nasogastric tube. His parents were being prepared for the infant's discharge from the unit within a few days.At 60 days of age, he developed sudden respiratory distress characterized by tachypnea and moderate retractions, with desaturations and periodic breathing. He was alert, afebrile, and active. A rapid deterioration with apnea necessitated bag and mask ventilation. He recovered from this episode but remained tachypneic and continued to have retractions and required nasal continuous positive airway pressure support and an FIO 2 of 1.0. The initial chest radiograph was normal. A complete blood count revealed a low hematocrit and an elevated white blood cell count with a significant increase in band forms. He was later intubated and ventilated mechanically because of worsening respiratory distress. After a blood culture was obtained, therapy with ampicillin, gentamicin, and cefotaxime was initiated. Cultures of cerebrospinal fluid and urine were obtained after the initiation of antibiotics. A chest radiograph revealed a patchy opacity in the right upper lobe that was consistent with an infiltrate or atelectasis.The patient remained afebrile and normotensive but developed a swelling on the left side of his face that became more prominent over the next 3 days. The swelling overlaid the angle of the mandible and extended to the submandibular and submental region. The overlying skin was warm and erythematous. A diagnosis of sepsis with acute cellulitis of the left side of the face was assumed. Cultures of the blood, urine, and cerebrospinal fluid were sterile. The antibiotic regimen was changed to nafcillin and cefotaxime.Radiologic evaluation of the mandible demonstrated a smooth periosteum with no evidence of periosteal elevation. Multiple grayscale and real-time sonograms demonstrated a large heterogeneous septated structure in the submandibular and submental region on the left side of the neck. Color-flow Doppler demonstrated increased vascularity around the mass. There were several areas of hilar-type vascularity that were suspicious for cervical adenopathy (Figure 1). The study was consistent with cervical lymphadenitis of the left neck. No discernible abscess was appreciated.The patient's clinical st...

Monolateral suppurative parotitis in a neonate and review of literature

“…Risk factors to parotitis include dehydration, low birth weight, immune suppression, ductal obstruction, oral trauma, and structural abnormalities of the parotid gland [4]. Sepsis and malnutrition can also predispose to the infection [9]. Preterm babies are at high risk of S. aureus parotitis [4], because of an increased risk of dehydration which may reduce salivary secretion causing salivary stasis that promotes bacterial ascent along the salivary duct [1].…”

“…Ultrasonography is also helpful in determining whether a parotid swelling has arisen secondary to enlargement of adjacent tissue or to the presence of an intraglandular mass, including an abscess [20,21]. The differential diagnosis include facial cellulitis, cervical or preauricular lymphadenitis, osteomyelitis, subcutaneous fat necrosis and abscess formation, buccinators muscles infection, haemangioma, adenoma, lipoma [9,22].…”

Parotiditis aguda en recién nacido

“…El aumento de volumen en la región parotídea es el signo más prevalente 1 y la secreción purulenta tras la compresión de la glándula se considera como signo patognomónico de la enfermedad 11,12 . La presentación unilateral es lo más frecuente 1 .…”

“…La infección se adquiere habitualmente por vía ascendente desde la cavidad oral a través del conducto de Stenon 5,6,8 . Sin embargo algunos autores han planteado también la vía hematógena 11 . La sialectasia desempeña un papel muy importante en la patogenia, ya que aumentaría la susceptibilidad de la glándula a la infección 6 .…”

“…La ecografía generalmente muestra hipoecogenicidad e hipervascularización 2,8 . La tomografía computarizada (TC) podría ser útil para confirmar o descartar compromiso extraparotídeo, así como para su diagnóstico diferencial (Tabla 2) 11,14 . En este caso el paciente efectivamente presentó leucocitosis de predominio polimorfonuclear, PCR elevada y ecografía concordante, no se le realizó amilasemia ni TC.…”