Images in Clinical Medicine
Suppurative Parotitis
N Engl J Med 2001; 345:662August 30, 2001
- Article
Figure 1 A 60-year-old woman with a history of metastatic neuroendocrine tumor presented with rapidly progressive swelling of the left side of the face. She was dehydrated and acutely ill, with a temperature of 36.1°C, a pulse of 106 per minute, and a blood pressure of 106/58 mm Hg. The left preauricular area of her face was markedly swollen, and a firm, tender mass was palpable. Pus was expressed from the parotid (Stensen's) duct. The white-cell count was 54,400 per cubic millimeter, with 41 percent segmented granulocytes and 20 percent band forms. A computed tomographic scan of the head with the intravenous administration of contrast medium showed an enhancing mass within the left parotid gland, but no evidence of abscess formation. Broad-spectrum parenteral antibiotics were initiated. Culture of the parotid-duct aspirate yielded Escherichia coli and Staphylococcus aureus. The blood cultures grew S. aureus with the same pattern of sensitivity as that of the organism recovered from the parotid duct. Over the next several days, the patient's facial swelling increased and there was purulent drainage from a sinus tract. With continued intravenous antibiotic treatment, the mass eventually decreased in size and did not require surgical incision. The patient was discharged from the hospital after 11 days while receiving oral antibiotics. At a follow-up examination, her parotitis had completely resolved.
Scott D. Lunin, M.D.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030Stephan Moll, M.D.
University of North Carolina School of Medicine, Chapel Hill, NC 27599
