Parotid abscess caused by Salmonella enteriditis in a patient with parotid masses

Abstract

Parotid abscess is a condition resulting from the progression of acute bacterial parotitis. It may be distinguished from acute parotitis by fluctuance, pitting, and loculated suppuration. Predisposing factors include dehydration, certain medications, some medical conditions, and an immunocompromised state. The typical bacterial organisms of a parotid abscess are similar to those seen with acute parotitis. The most common organism isolated is Staphylococcus aureus. Additional bacterial pathogens include Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Haemophilus influenzae, and oral anaerobes (Bacteroides and Peptostreptococcus). Infection of the parotid gland by Salmonella species has been reported in immunocompromised individuals, as well as patients with histories of recent gastrointestinal illness. We describe a case of parotid abscess caused by Salmonella enteriditis in an otherwise healthy patient with known parotid masses. A 75-year-old white man with a 5-year history of bilateral parotid masses presented to the otolaryngology clinic with complaints of a new onset of right-sided facial pain. During his initial evaluation 5 years previous, an (MRI) Magnetic resonance Imaging scan showed bilateral intraparotid masses consistent with Warthin’s tumor. The MRI estimated the right parotid neoplasm to be 4 3 4 cm, and the left to be 3 2 3 cm. The patient was asymptomatic and declined surgical intervention at that time. Two days before the most recent presentation, he experienced a sudden onset of right-sided facial pain, for which he took acetaminophen with adequate relief. The pain became progressively worse over the following 2 days and was refractory to acetaminophen and ibuprofen. The day before presentation he reported having a fever, which was not measured. On the day of presentation he noted a significant increase in pain and the size of the right parotid/facial mass. He denied any nausea, vomiting, diarrhea, or abdominal cramps. The patient denied regular use of alcohol or tobacco. Past surgical history, past medical history, family history and social history were noncontributory. The patient is not an intravenous drug user and has never received a blood transfusion. He denied recent ingestion of eggs or poultry. He had no recent exposure to reptiles. On physical examination, the patient was in mild distress. Visual inspection showed significant facial assymetry. There was a protuberance of tissue in the parotid regions bilaterally, especially on the right. Gross examination showed a 6 by 8 cm right parotid mass with decreased mobility and no skin fixation. There was a small amount of skin erythema near the mass center. On palpation, the area was found to be firm and tender without discrete nodules or fluctuance. No purulence was expressed from Stensen’s duct, and there was flow of clear saliva. The left parotid mass was 3 by 4 cm; it was soft and nontender without erythema. Facial nerve function was intact bilaterally. The remainder of the examination, including flexible fiberoptic laryngoscopy, was unremarkable. The patient underwent fine needle aspiration and a second MRI of the lesion. The fine From the Naval Medical Center Portsmouth, Portsmouth, VA. Address reprint requests to Shawn D. Kosnik, DO, LT MC USN, Naval Medical Center Portsmouth, Charette Health Care Center, 27 Effingham Street, Portsmouth, VA 23708-5000. This is aUSgovernmentwork. There are no restrictions on its use. 0196-0709/02/2302-0001$0.00/0 doi:10.1053/ajot.2002.31217