LOCALIZACIÓN INUSUAL DE SEPSIS, PAROTIDITIS AGUDA SUPURATIVA BILATERAL

Abstract

INTRODUCTION:The suppurative acute parotitis is a bacterial infection caused more frequently by the S. aureus (80%). Before the antibiotics were discovered, this manifestation appeared after an abdominal surgery. Nowadays, it is considered a rare event (0.01% incidence) and it is seen in weakened and dehydrated patients. When a bilateral affectation, a differential diagnosis must be done between infectious diseases as the HIV, tumors as the Whartin ones, autoimmune diseases as the Sjögren syndrome and iatrogenic as a consequence of general anesthesia. The most frequent clinical features are the gland induration, heat, blushing, fever and pain. The Stenon duct may be flushed and it may drain purulent content when the gland is massaged. The use of images such as an ultrasound or a CT scan, it may help reaching a diagnosis and discarding the presence of purulence within the parenchyma. The treatment of this disease is based on antibiotic therapy and hydration. Nevertheless, a surgical drainage is sometimes needed when there is not a clinical improvement or the facial nerve is compromised.METHODS:A 61-year-old patient with a partial bowel obstruction is admitted to the Intensive Care Unit because of a sepsis and disseminated intravascular coagulation. A consult is made to the otolaryngologists because of the appearance of bilateral bacterial parotitis. During the physical exam, severe mucosal dehydration and an increase of both parotid glands are noticed. These are painful when are touched and plenty of pus is drained through the left Stenon duct after its massage. A culture of pus and the hemoculture are positive for meticilin sensible Staphilococcus aureus, indicating the parotitis as the main cause of the sepsis. An ultrasound is made at both the glands in various occasions to assess the need to drain any collection of pus, otherwise no liquid collections are seen. An MRI is made, revealing the presence of multiple collections bilaterally, most of them under a centimeter, the biggest one is in the superficial area of the left parotid gland. Serologies are made in order to dismiss the presence of HIV. After intravenous antibiotic therapy, the patient slowly recovered and could be released from the hospital. Nowadays, she is waiting for a left parotidectomy to be performed on her.CONCLUSIONS:The appearance of a bilateral suppurative parotitis after a surgery with preoperative antibiotic therapy is unusual. When it does appear, some important complications such as an infectious sepsis must take into consideration.A good differential diagnosis should be made in order to discard any underlying diseases that may be the cause of it.This disease’s treatment consists in the intravenous antibiotic therapy, together with the purulence drainage through the Stenon duct or by performing an open surgery.