SAEM Clinical Image Series: Facial Swelling in a 2 Year Old
History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.
He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.
Vitals: Tachycardic, temperature of 38.2 C.
HEENT: Left sided facial swelling where skin is taught and mildly discolored. Non-tender to touch and no fluctuation is appreciated. Swelling includes left cheek and submandibular region. The rest of the examination is normal.
Upon re-examination 6 hours later, swelling has progressed to include his left peri-orbital region as well as left ear and neck.
CBC: WBC of 11.7 bil/L
CRP: Elevated to 24.6 mg/L
ESR: Normal
Rapid flu/RSV swab: Positive for influenza A
Mumps IgM/IgG: Pending
Parotitis secondary to influenza virus
The CT image shows the inflamed parotid gland.
Take Home Points
- Parotitis is a known complication of influenza virus but the incidence is not well known
- Typically appears in children and more commonly in males
- Influenza should be included in the differential for a pediatric patient presenting with parotitis during the winter months
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