Dr.Akshay Kishore ,Dr.Suma Balan,
DrC .Jayakumar
Four year female immunized as per NIS schedule presented with recurrent bilateral parotid gland swelling once ina month for the last years two years
No history of pallor, lymphadenopathy ,perioral ulcers/joint pain or swelling /genital ulcers /rash/dry mouth or dry eyes
His auxology is normal for his age
Differentials
1Bilateral salivary duct calculi
2Acquired immunology deficiency
3Juvenile recurrent parotitis
4Sjogrens syndrome
5Mumps – less likely because child is vaccinated
6Infections- Streptococcus or EBV.
On examination –
No dental caries /dry mouth
Left parotid gland swelling is tender on touch.”
Systemic examination within normal limits.
Labs CBC CRP with normal
ESR -21mm/hr.
LDH normal.
DCT and pre-op serology (HIV,HepB,HepC )negative.
Immunoglobulin levels normal
Peripheral smear and basic lymphocyte subset analysis within normal limits.
ANA IFA was negative.
USG neck showed bulky left parotid gland with multiple focal hypoechoiec small nodules diffusely scattered in parenchyma and few intra parotid lymph node.
No calculi or duct dilatation seen. Findings consistent with bilateral parotitis – chronic /recurrent.
Ophthalmology consult was given and uveitis was ruled out.
Child was started on Naproxen (20mg/kg/day).
ENT consultation
Parotid biopsy showed chronic sialadenitis and lip biopsy did not show any features of Sjögren’s disease.
Discussion: Juvenile recurrent parotitis (JRP)is the second most common cause of parotitis in childhood only after mumps. Seen between 3-6 years of age. Symptoms usually resolve spontaneously after puberty.
Pathogenesis of JRP is decreased salivary production with insufficient salivary gland outflow. Treatment ranges from conservative treatment such as analgesics, good oral hygiene , massage of parotid gland to parotid duct ligation and parotidectomy.
Carry home message: Every parotid gland swelling is not Sjögren’s syndrome or due to mumps infection
