Neonatal Suppurative Parotitis: A Case Report

Dear Editor Neonatal suppurative parotitis (NSP) is rare; fewer than 90 cases were reported before 1970[1]. A study by Spiegel et al identified only 32 cases in the English literature between 1970 and 2004[2]. Another study by Ismail et al identified 12 new cases in the English literature since 2004[3]. We are reporting another case. Most cases were male (77%) and one third of them were preterm infants[2,3]. Staphylococcus aureus was the most frequent offending organism. Ascending infection from the oral cavity through Stensen’s duct or, less commonly, hematogenous seeding of the parotid gland have both been implicated in the development of NSP[4]. Several risk factors for the development of NSP are recognized: dehydration, prematurity, excessive oropharyngeal suction, prolonged gavaging, ductal obstruction and immune suppression[2,3]. Typically, infants present in the second week of life with parotid gland swelling, fever and erythema in the overlying skin. Purulent material can drain spontaneously or be expressed from the Stensen’s duct. A 19-day-old female infant presented with a 3day history of fever, irritability, and right-sided periauricular swelling [Fig. 1]. She was born at 37 weeks + 3days gestation via normal vaginal delivery. Pregnancy was uneventful. Birth weight was 3200 g. On admission the baby was irritable. Her weight was 3450 g, and rectal temperature 38°C. A diffuse, tender, unilateral swelling in the right parotid region was observed. It was warm to touch and fluctuated. The rest of the physical examination was unremarkable. The mother reported no history suggestive of mastitis or recent infection. Initial laboratory tests were as Fig. 1: 19-day-old female infant with right-sided periauricular swelling follows: white blood cell count 18600/mm3 with 53.4% neutrophils and 41% lymphocytes, hemoglobin 9.5 g/dl and erythrocyte sedimentation rate (ESR) 42 mm/h. Ultrasound examination of the mass demonstrated a cystic mass with septation and debris in the right parotid. Percutaneous aspiration of fluctuant area of the parotid gland was done and sample sent for culture. After obtaining blood and cerebrospinal fluid for culture empiric therapy with amikacin, vancomycin and ceftazidim was initiated. Surgical drainage was done 12 hours later. After four days of therapy, the swelling was not regressed. Culture of parotid abscess showed Staphylococcus aureus growth. With regard to antibiogram, clindamycin and meropenem was started and vancomycin and ceftazidim discontinued. Thereon blood culture, cerebrospinal fluid analysis and culture were normal. Daily drainage was not needed and after 10 days of therapy she was discharged. To our knowledge, acute bacterial infection of parotid gland in the neonatal age has not been Letters to Editor Iran J Pediatr Aug 2014; Vol 24 (No 4), Pp: 451-456