Bilateral parotitis

Background

Parotid anatomy.

• Bilateral parotid gland swelling has a broad differential
• May be infectious, inflammatory, or systemic in etiology
• Mumps was the most common cause historically; now rare due to vaccination

Clinical Features

• Swelling over both parotid glands (preauricular, extending to angle of mandible)
• +/- overlying erythema, tenderness, constitutional symptoms
• Purulent discharge from Stensen duct suggests bacterial parotitis
• Bilateral painless enlargement raises concern for systemic disease (HIV, sarcoidosis, Sjögren syndrome, bulimia)

Differential Diagnosis

Bilateral Parotitis

• Viral infections
  • Viral parotitis
  • Parainfluenza
  • Coxsackie virus
  • influenza A
  • Epstein-Barr virus
  • Adenovirus
  • HIV
  • Cytomegalovirus
• Bacterial infections
  • Staphylococcus aureus
• Noninfectious
  • Salivary calculi
  • Tumors
  • Sarcoidosis
  • Sjögren’s syndrome
  • Thiazide diuretics

Evaluation

• History: fever, duration, vaccination status, HIV risk factors, sicca symptoms, medication review
• Exam: palpate glands, express Stensen duct (purulence suggests bacterial infection), assess trismus
• Labs: CBC, lipase/amylase (elevated in parotitis), consider mumps IgM if unvaccinated
• CT with contrast if concern for abscess, deep space infection, or malignancy
• Consider HIV testing, ESR/CRP, and SS-A/SS-B antibodies if systemic cause suspected

Management

• Infectious: Antibiotics (cover staph and streptococci — amoxicillin/clavulanate or clindamycin), warm compresses, sialagogues, hydration, parotid massage
• Viral (mumps): Supportive care, droplet precautions, report to public health
• Abscess: ENT/surgery consult for I&D
• Systemic: Treat underlying condition

Disposition

• Discharge most viral and uncomplicated bacterial parotitis with antibiotics and follow-up
• Admit for abscess, severe infection, airway compromise, or inability to tolerate PO

See Also

• Parotitis
• Mumps