A couple weeks ago I was caring for a patient on the heme-onc service that developed progressive L-sided neck/face swelling over 3-4 hours! He ended up having suppurative parotitis, a diagnosis I have not seen very much in practice. Here are some takeaways #MedTwitter
Risk fxrs for suppurative parotitis include poor PO intake, poor dentition/recent dental work, oropharyngeal malignancies, & intubation (all via impaired stimulation/drainage of salivary ducts). The most common offending bugs are Staph Aureus & anaerobes (pubmed.ncbi.nlm.nih.gov/12544218/) 
Both US and CT can be used as imaging modalities in the workup of suppurative parotitis. US can identify a potential obstructing stone more easily while CT is more sensitive for ruling out an abscess. Another diagnostic hint is elevated amylase w/ normal lipase
If you can obtain culture data via FNA or from salivary duct purulence, go ahead and collect it! Initial Abx coverage should cover MRSA along with mixed anaerobes/aerobes. Immunocompromised pts may need more extensive Gram(-) coverage
In addition to Abx, fluid resuscitation is essential. Surgical management may be necessary if an abscess is identified or there is concern for tracking into the retropharyngeal space
So in summary:
- add suppurative parotitis to your ddx for rapidly progressive unilateral face/neck swelling
- common bugs: S aureus + anaerobes
- Abx and fluids are initial mgmt, may need surgery if abscess or extension into retropharyngeal space
Additional thoughts welcome!
- add suppurative parotitis to your ddx for rapidly progressive unilateral face/neck swelling
- common bugs: S aureus + anaerobes
- Abx and fluids are initial mgmt, may need surgery if abscess or extension into retropharyngeal space
Additional thoughts welcome!
