Abstract
This case is a single submandibular gland mumps viral infection patient without parotid gland involvement who developed complications of meningitis and orchitis. Since spontaneous remission is common in mumps viral infection, missing opportunities for exact diagnosis is frequent. As in this case, single submandibular glands infection without parotid gland involvement not only delays diagnosis but also increases risk of developing complications. This case instructs us that despite the atypical manifestation, the clinician should suspect mumps and conduct serologic tests for diagnosis while observing for complications such as meningoencephalitis and orchitis.
1
Introduction
Mumps virus is a paramyxovirus infection involving salivary glands, especially the parotid glands. Mumps virus can be transmitted by saliva, droplet, urine, and air-borne transmission. If diagnosis is early allowing suitable treatment, mumps virus infection can be treated while avoiding complications like sudden sensory–neural hearing loss, pancreatitis, aseptic meningitis, and orchitis. Clinically, parotid swelling and tenderness raise suspicion of mumps virus infection. Extraparotid manifestations are rare and can be cause delay of diagnosis.
Here, we describe an unusual case with submandibular gland involvement without the parotid gland, who developed complications of orchitis and meningitis.
2
Case report
An 18-year-old man presented with a three day history of bilateral submandibular swelling and local tenderness. General myalgia and febrile reaction continued in spite of emergency room care. He had no history of allergy, previous sialoadenitis, underlying medical disorder or family history.
Physical examination revealed tender bilateral submandibular region masses that on palpation were about 3 × 3 cm with multiple cervical level I, II, III. There was no Wharton’s duct pus discharge suggesting a bacterial infection. A computed tomography (CT) scan showed enlargement of bilateral submandibular glands to about 4 × 3 cm with subcutaneous and platysma thickening. Bilateral high and middle internal jugular lymph nodes were enlarged ( Fig. 1 ).
Laboratory tests showed a slight increase of inflammatory parameters but elevated amylase level. The mumps virus titers were both positive for immunoglobulin M [Ig M], and immunoglobulin G [Ig G, 1:64]. The submandibular lesion was provisionally considered a viral infection and secondary bacterial infection. The patient was treated intravenously with third generation cephalosporin. The patient suffered mild nausea and vomiting starting the fourth day after admission. Right testicular pain and a swelling headache appeared on the fifth day.
A testicular Doppler test showed acute orchitis ( Fig. 2 ), and cerebrospinal fluid (CSF) analysis revealed viral meningitis. Fever and malaise disappeared gradually on the fifth day while submandibular swelling and tenderness subsided on the seventh day. The patient was referred to the neurology department and treated conservatively. He was discharged on the fourteenth day after symptoms of headache, nausea and vomiting resolved completely.
2
Case report
An 18-year-old man presented with a three day history of bilateral submandibular swelling and local tenderness. General myalgia and febrile reaction continued in spite of emergency room care. He had no history of allergy, previous sialoadenitis, underlying medical disorder or family history.
Physical examination revealed tender bilateral submandibular region masses that on palpation were about 3 × 3 cm with multiple cervical level I, II, III. There was no Wharton’s duct pus discharge suggesting a bacterial infection. A computed tomography (CT) scan showed enlargement of bilateral submandibular glands to about 4 × 3 cm with subcutaneous and platysma thickening. Bilateral high and middle internal jugular lymph nodes were enlarged ( Fig. 1 ).
