Abstract | May 5, 2021

Parotitis as a presentation of COVID Infection

Presenting Author: Sangeetha Isaac, MD, Internal Medicine Resident PGY1, Department of Medicine, North Alabama Medical Center, Florence, Alabama

Coauthors: Mohammed Afraz Pasha, MD, Internal Medicine Resident PGY1, Florence, Alabama, Saquib Anjum, MD, Associate Program Director, Internal Medicine Residency Program and Director of Geriatrics Service, Florence, Alabama, Jean Vincent, MD, Core Faculty, Internal Medicine Residency program and Director of Infectious Disease Service, Florence, Alabama, Khushdeep Chahal, MD, Program Director of Internal Medicine Residency Program, and Chair, Department of Medicine, Florence, Alabama

Learning Objectives

  1. Acute viral parotitis begins as a systemic infection that localizes to the parotid gland, resulting in inflammation and swelling of the gland. Mumps, or paramyxovirus, has a predilection for the parotid gland and classically has been linked to parotitis. The virus replicates in the upper respiratory tract and spreads by direct contact or airborne transmission;
  2. Parotitis in COVID, could be related to intraparotid lymph node enlargement. The parotid gland contains 3 to 24 lymph nodes.

Coronavirus disease (COVID) usually presents with fever, respiratory and gastrointestinal issues. COVID infection presenting as parotid inflammation is sparsely reported in literature to date, though other viruses like mumps and rubella commonly cause parotitis. We present a patient with parotitis who tested positive for COVID.

Case Presentation:
A 71-year-old Caucasian gentleman presented to the emergency with complaints of neck pain for 1 week. He also had episodic chest pain and dyspnea for past 2 months. He had been started on doxycycline for parotitis prior to this visit. After starting doxycycline, his parotid swelling had significantly reduced, but he developed diarrhea, headache and visual hallucinations, which prompted the ER visit. He did not have any significant risk factors for parotitis. Two months before this presentation, he had contracted COVID which was appropriately managed and repeat tests were reportedly negative.

On admission patient was afebrile and vitally stable. He had no swelling over the face or neck, but mild tenderness at the angle of mandible could be elicited. Respiratory system was unremarkable. Initial investigations revealed neutrophil predominant leukocytosis. CT scan of the neck showed bilateral prominent parotid glands and inflammatory changes on right side of the neck predominantly posterior to the right sternocleidomastoid muscle, with prominent level 2 lymph nodes measuring 18 x 7 mm. Incidentally, ill-defined patchy bilateral upper lobe lung opacities were noted with 3.8cm bulla in the lateral aspect of the left upper lobe. Chest X-ray showed no acute infiltrates but linear fibrotic changes were noted bilaterally. In view of this finding, he was tested for COVID with qualitative detection of RNA and was found to be positive.

Final Diagnosis:
Parotitis likely secondary to SARS-CoV2 infection.

Followup and discussion:
As knowledge about COVID is evolving everyday, our patient highlights the rare presentation of parotitis in the setting of COVID. Atypical presentations could be related to COVID induced cytokine storm which has a potential to affect any organ. A case series reported 3 patients with parotitis in COVID and suggested possible intraparotid lymph node enlargement, which is different from other viral parotitis. This could be an explanation for the pathophysiology.

Posted in: Infectious Disease9