Partial facial paralysis induced by sialolithiasis of the parotid gland: a case report.

BACKGROUND: Facial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians. CASE PRESENTATION: A 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen's duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis. CONCLUSIONS: This case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient's recovery and prevention of long-term complications.

Salivary gland ultrasound in clinical practice: What is its real usefulness?

BACKGROUND: Salivary gland ultrasound (SGU) provides information about structural gland abnormalities that can be graded and used for primary Sjögren's syndrome (pSS) diagnosis. Its potential role as a prognostic marker for detecting patients at high risk of lymphoma and extra-glandular manifestations is still under evaluation. We aim to assess the usefulness of SGU for SS diagnosis in routine clinical practice and its relationship with extra-glandular involvement and lymphoma risk in pSS patients. METHODS: We designed a retrospective observational single-center study. Data was collected using the electronic health records of patients referred to an ultrasound outpatient clinic for evaluation over a 4-year period. Data extraction included demographics, comorbidities, clinical data, laboratory tests, SGU results, salivary gland (SG) biopsy, and scintigraphy results. Comparisons were made between patients with and without pathological SGU. The external criterion for comparison was the fulfillment of the 2016 ACR/EULAR pSS criteria. RESULTS: A total of 179 SGU assessments were included from this 4-year period. Twenty-four cases (13.4%) were pathological. The most frequently diagnosed conditions prior to SGU-detected pathologies were pSS (9.7%), rheumatoid arthritis (RA) (13.1%), and systemic lupus (4.6%). One hundred and two patients (57%) had no previous diagnosis (sicca syndrome work-up); of these, 47 patients (46.1%) were ANA positive and 25 (24.5%) anti-SSA positive. In this study, the sensitivity and specificity of SGU for SS diagnosis were 48% and 98% respectively, with a positive predictive value of 95%. There were statistically significant relationships between a pathological SGU and the presence of recurrent parotitis (p=.0083), positive anti-SSB antibodies (p=.0083), and a positive sialography (p=.0351). CONCLUSIONS: SGU shows high global specificity but low sensitivity for pSS diagnosis in routine care. Pathological SGU findings are associated with positive autoantibodies (ANA and anti-SSB) and recurrent parotitis.

Pulmonary manifestations of childhood-onset primary Sjogren's syndrome (SS) masquerading as reactive airways disease in a male patient and review of interstitial lung disease associated with SS.

BACKGROUND: Sjogren's syndrome (SS) is a rare chronic autoimmune disease involving exocrine glands presenting with sicca syndrome, recurrent parotitis and other extraglandular stigmata. SS is well characterized in the adult population with classification criteria; however, primary SS presenting in childhood is poorly defined and rare in males. Recurrent parotitis is the most common presenting symptom in children with primary SS; however, clinical phenotype in children appears more variable than in adults. The lungs are a common extraglandular location for manifestations of primary SS. However, interstitial lung disease (ILD) is rare in children with primary SS. There are only four published reports of ILD associated with primary SS in female children. Here, we present a very rare case of primary SS in a pediatric male with pulmonary manifestations and review of the literature on ILD in childhood-onset primary SS. CASE PRESENTATION: A 14-year-old White male with a history of chronic severe asthma, recurrent parotitis and idiopathic intracranial hypertension was referred to pediatric rheumatology for evaluation of a positive ANA. In early childhood, he was diagnosed with persistent asthma recalcitrant to therapy. At age 8, he developed recurrent episodes of bilateral parotitis despite multiple treatments with sialoendoscopy. At age 14, respiratory symptoms significantly worsened prompting reevaluation. Lab workup was notable for positive ANA and Sjogren's Syndrome A and B antibodies. Pulmonary function tests showed only a mild obstructive process. Computed tomography of chest was significant for small airway disease, and lung biopsy was positive for mild interstitial lymphocytic inflammation presenting a conflicting picture for ILD. The constellation of findings led to the diagnosis of primary SS with associated pulmonary manifestations. He was treated with hydroxychloroquine, mycophenolate mofetil and oral corticosteroids with resolution of symptoms. CONCLUSIONS: Primary SS is a rare disease in the pediatric population that is poorly characterized. This case is the very rare presentation of childhood-onset primary SS with pulmonary manifestations in a male patient. ILD associated with primary SS is also very rare with only four pediatric patients reported in the literature. Collaborative effort is needed to develop pediatric specific diagnostic and treatment guidelines in this rare condition.

Is seminal quality worsening? A 20-year experience in Córdoba, Argentina.

PURPOSE: To assess the possible variations in semen quality during the last 20 years in Córdoba, Argentina, and to identify possible causal lifestyle or genitourinary factors. METHODS: Retrospective study of 23,130 patients attending an andrology laboratory. The 20-year period (2001-2020) was divided into four quinquenniums. Seminal parameters (sperm concentration, motility, morphology, viability, and membrane functional integrity) were classified as normal or abnormal according to WHO, and results were expressed as percentage of patients abnormal for each parameter per quinquennium. In addition, the percentage of patients per quinquennium exposed to the different risk factors (daily alcohol and/or tobacco consumption; occupational exposure to heat or toxics; history of parotitis or varicocele; and high body mass index, BMI) was reported. RESULTS: Patients included in our study did not show impairment in seminal quality over time. Beyond a transient decrease in normozoospermia in the second and third quinquennium, possibly explained by a parallel increase in teratozoospermia, other important parameters of the spermogram did not change. In fact, abnormalities in sperm concentration (oligozoospermia), total sperm count, viability and response to hypoosmotic test showed a decreasing trend over time. On the other hand, parotitis, varicocele, morbid obesity and regular exposition to heat/toxics were the factors more frequently associated with semen abnormalities; the last two increased their frequency over the study period. CONCLUSION: The population included in this study did not show a clear impairment in semen quality during the last 20 years. The decreasing patterns found were associated with high BMI and exposure to heat/toxics.

The effect of point-of-care ultrasound on length of stay in the emergency department in children with neck swelling.

BACKGROUND: Ultrasound is the imaging modality of choice in children presenting to the emergency department (ED) with soft tissue neck swelling. Point of care ultrasound (POCUS) has good accuracy when compared to comprehensive radiology department ultrasound (RADUS). POCUS could potentially improve ED length of stay (LOS) by improving efficiency. We aimed to evaluate the LOS of pediatric patients seen in ED with soft tissue neck swelling who received POCUS compared to RADUS. We determined unscheduled 30-day return visit rates in both groups as a balancing measure. METHODS: We performed a retrospective review of the electronic medical record for our cross-sectional study of discharged patients ≤21 years of age who had a neck ultrasound performed by a credentialed POCUS physician or by the radiology department between July 2014 and January 2020. We included patients who had both POCUS and RADUS in the POCUS group. We compared median ED LOS in both groups using the Mann Whitney U test and proportion of unscheduled return visits to the ED in both groups using odds ratio and 95% CI. RESULTS: There were 925 patients: 76 with only POCUS, 6 with POCUS and RADUS, and 843 with only RADUS performed. Median LOS in the POCUS group was 68.5 min (IQR 38.3120.3) versus 154.0 min (IQR 111.0, 211.0) in the RADUS group (p < 0.001). Return visit overall was 7.6%: 13.2% in the POCUS group versus 7.1% in the RADUS group (p = 0.07). CONCLUSION: Pediatric patients evaluated in the ED for soft tissue neck swelling had a shorter LOS with POCUS than with RADUS without a statistically significant increase in 30-day return visits. We suggest a "POCUS First" approach to the care of these patients.

Parotitis on Ultrasound: The Pomegranate Sign.

The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.

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.

Simultaneous parotitis and ipsilateral herpes zoster ophthalmicus: coincidence?

A 43-year-old previously healthy man presented to the primary care clinic with concurrent ipsilateral viral parotitis and herpes zoster ophthalmicus. The patient experienced painful swelling below the right ear as well as painful vesicles on the right forehead, eyelid and cheek in the V1 dermatomal region. There were no lesions in the oral cavity or nose. Antibody titres confirmed active varicella zoster virus in the absence of mumps or herpes simplex virus 1 and 2 and unilateral parotitis were confirmed to be non-suppurative by the patient's primary care physician and the neurologist. Both conditions resolved within 3 weeks with appropriate treatment.

Parotiditis recurrente y déficit de células natural killer: ¿coincidencia o patogenia? / Juvenile recurrent parotitis and natural killer cells deficiency, coincidence or pathogenesis?

La parotiditis recurrente juvenil puede tener multitud de causas, es importante tener en cuenta, dentro de la etiología, el estudio de las subpoblaciones linfocitarias, ya que puede haber una relación patogénica con la deficiencia de células natural killer. Se presenta el caso clínico de una paciente de diez años con parotiditis recurrente secundaria a dicho proceso

Juvenile recurrent parotitis may have many causative factors. It is important to make an study of lymphocyte subsets, due to natural killer cells deficiency could be pathogenic. The clinical case of a 10-year-old patient with recurrent parotitis secondary to this process is presented

Absceso parotídeo y mastitis por Staphylococcus aureus resistente a Meticillina en un neonato / Parotid abscess and mastitis by Methicillin- resistant Staphylococcus aureus in a newborn

Introducción: La parotiditis supurativa aguda se presenta con poca frecuencia en el período neonatal. Objetivo: Aportar un nuevo caso de parotiditis supurativa aguda por Staphylococcus aureus resistente a la Meticillina. Presentación del caso: El presente caso tiene la particularidad de que presentó foco de infección inicial (impétigo y conjuntamente mastitis bilateral), en el que se demostró el mismo microorganismo causal de la infección: Staphylococcus aureus resistente a la Meticillina. La mastitis bilateral evolucionó hacia la formación de absceso. En la literatura revisada solo se encontraron tres publicaciones que tratan de neonatos con un foco inicial de infección en sitios diferentes de la parotiditis. Estos aspectos fueron los que motivaron la presentación del caso. Conclusiones: Staphylococcus aureus resistente a la Meticillina ha emergido en los últimos años como agente causal de parotiditis supurativa aguda, que puede diseminarse hacia otro foco infeccioso, habitualmente se logra la curación con tratamiento antibiótico ajustado al agente causal, concretamente con Vancomicina, aunque puede requerir también tratamiento quirúrgico si ocurre abscedación(AU)

Introduction: Acute suppurative parotitis occurs infrequently in the neonatal period. Objective: To provide information of a new case of acute suppurative parotitis caused by Methicillin- resistant Staphylococcus aureus. Case presentation: The present case has the particularity that the patient presented a source of initial infection (impetigo and jointly bilateral mastitis), in which the same causal microorganism of the infection was found: Methicillin resistant Staphylococcus aureus. Bilateral mastitis evolved to the formation of abscess. In the literature reviewed, there were only 3 publications on neonates who presented an initial source of infection in sites different from parotitis. These aspects are those that motivated the presentation of this case. Conclusions: Methicillin resistant Staphylococcus aureus has emerged in the last years as a causal agent of acute suppurative parotitis that can lead to dissemination of another source of infection. Normally, the cure is achieved with antibiotic treatment adjusted to the causal microorganism, specifically with Vancomycin; although it can require surgical treatment if abscesses occurs(AU)

Non-IgG4-related Multifocal Fibrosclerosis.

Multifocal fibrosclerosis (MFS), which causes systemic and chronic connective tissue inflammation, has been associated with IgG4 and regarded as an identical entity with "IgG4-related disease (IgG4-RD)". Although a few cases of MFS mimicking IgG4-RD histopathologically, despite the absence of a serum IgG4 elevation and IgG4-positive plasma cell infiltration, have been reported, there is, so far, little information regarding such exceptional cases. We herein demonstrate a case of non-IgG4-related MFS presenting with periaortitis and parotiditis, whose histological findings were consistent with IgG4-RD despite the absence of elevated serum and tissue IgG4 levels.

Sordera súbita profunda tras administración de vacuna triple vírica / Sudden deafness versus deep MMR vaccine

Trabajadora sanitaria sin protección frente al virus de la parotiditis a la que se administra la primera dosis de la vacuna triple vírica (sarampión, rubeola, parotiditis). Tres semanas después acude al servicio de Otorrinolaringología (ORL) por sensación de taponamiento súbito y tinnitus en oído izquierdo de varias horas de evolución, diagnosticándose sordera súbita. Es ingresada con tratamiento intravenoso de corticoides y, tras agotar posibilidades terapéuticas, es dada de alta sin recuperación de la audición. Acude al Servicio de Prevención del hospital para notificar lo ocurrido. Desde este Servicio se intenta establecer el nexo causal entre la administración de la vacuna y la hipoacusia, informando y asesorando a la trabajadora de los trámites legales y administrativos en relación al caso (AU)

Health worker without protection against mumps to which the first dose is administered measles, mumps, and rubella vaccine Three weeks later presents to the Otolaryngology by plugging sudden feeling left ear and tinnitus in several hours of evolution diagnosed sudden deafness. It is entered treatment with intravenous corticosteroids and after exhausting therapeutic possibilities, it is discharged without recovery of hearing. The Department of Prevention tries to establish the causal link between the administration of the vaccine and hearing loss informing and advising the working of the legal and administrative procedures relating to the case (AU)

Asistolia por compresión del seno carotídeo: una complicación potencialmente fatal de la parotiditis vírica / Asytolia due to compression of the carotid sinus: a potentially fatal complication of viral parotiditis

La parotiditis es una enfermedad vírica aguda, caracterizada por fiebre e hinchazón dolorosa de una o más glándulas salivales, generalmente la parótida, aunque pueden afectarse las glándulas submaxilares y sublinguales. El cuadro clínico inicial es inespecífico, aunque en las primeras 24 h suelen aparecer otalgia y sensibilidad dolorosa en la parótida. Además, pueden aparecer complicaciones a nivel extraglandular, sobre todo a nivel neurológico, testicular, pancreático, articular y cardíaco. Entre estas últimas, las más frecuentes son los cambios electrocardiográficos. También está ampliamente descrita la miocarditis vírica. Presentamos una rara complicación, no descrita en la literatura, de asistolias recurrentes provocadas por la compresión del seno carotídeo, debido a la inflamación local producida por la parotiditis (AU)

Mumps is an acute viral disease, characterized by fever and painful swelling of one or more salivary glands, usually the parotid, and sometimes the sublingual or submandibular glands. The initial clinical picture is non-specific, but during the first 24 h there is otalgia and tenderness in the parotid gland. Apart from the involvement of the salivary glands, neurological, testicular, pancreatic, joint, or cardiac complications may occur. Among the latter, the most frequent are the electrocardiographic changes. Viral myocarditis has also been widely reported. We report a rare complication, not yet described in the literature, of recurrent asytolia produced by compression of the carotid sinus as a result of local inflammation caused by mumps (AU)

Parotiditis crónica recurrente juvenil / Infantile recurrent parotitis

La parotiditis crónica recurrente es una patología que cursa con inflamación parotídea unilateral o bilateral. Afecta a edades pediátricas y tiende a desaparecer con la edad. El objetivo es presentar esta patología infrecuente que, sin embargo, es de fácil diagnóstico y manejo de forma ambulatoria. Se presentan dos casos de esta patología de nuestro centro. Esta patología puede ser tratada de forma ambulatoria con analgesia, antiinflamatorios y, en caso de sobreinfección bacteriana, adjuntando antibioterapia. Las pruebas complementarias indicadas son la ecografía y la analítica sanguínea. Es una patología con buen pronóstico y tratamiento simple. Es importante realizar un buen diagnóstico diferencial. Suele desaparecer conforme el paciente se acerca a la edad adolecente (AU)

Infantile recurrent parotitis is a disease characterized by unilateral or bilateral parotid swelling. It appears in childhood and usually disappears during adolescence. The objective is to present this rare disease which has an easy treatment and diagnosis. We report two cases of this disease from our hospital. This condition can be treated with outpatient treatment, with analgesics, anti-inflammatory drugs and, if there is bacterial infection, also with antibiotics. As additional tests, blood tests and ultrasound are recommended. It is a disease with good prognosis and simple treatment. Differential diagnosis is very important. It usually disappears as the patient approaches the adolescence (AU)

Acute suppurative parotitis caused by Streptococcus pneumoniae in an HIV-infected man.

We report a case of a 32-year-old man who presented with progressive unilateral parotid gland enlargement and subsequently tested positive for HIV. A CT scan of the neck performed with contrast showed a phlegmon in the region of the right parotid tail measuring approximately 2.5×2.4 cm. Cultures of the aspirated fluid grew Streptococcus pneumoniae and the S. pneumoniae urinary antigen test was also positive. The patient underwent surgical debridement and received antimicrobial therapy with complete resolution of the parotitis. Parotitis caused by S. pneumoniae is rare, and HIV infection should be suspected in any case of invasive pneumococcal disease.