Bilateral Acute Suppurative Parotitis in a 9-Month-Old Infant Managed Conservatively: A Rare Case Report

Abstract

Background: Acute suppurative parotitis is uncommon in infants and is rarely observed beyond the neonatal period. When bilateral, its clinical presentation may resemble viral parotitis, cervical lymphadenitis, or deep-neck-space infection. Early high-resolution ultrasonography may help identify a potentially drainable collection or abscess. Case Description: A 9-month-old, fully immunised girl presented with upper respiratory catarrh of 10 days' duration, low-grade fever for 2 days, and a painful, rapidly enlarging right parotid swelling for 1 day. Marked systemic inflammation was evident (CRP, 356.59 mg/L), and microcytic hypochromic anaemia was noted. High-resolution ultrasonography of the right parotid region showed a large, heterogeneous parotid gland with increased Doppler vascularity and reactive cervical lymphadenitis, without a drainable fluid collection. Intravenous cefotaxime and amikacin, together with empirical oral cloxacillin, were initiated. After 48 hours, the swelling had progressed to involve both parotid glands. Following paediatric surgical review, antimicrobial therapy was escalated to intravenous meropenem, vancomycin, and metronidazole to cover possible multidrug-resistant pathogens, including MRSA and anaerobes. Because of the parents' concerns regarding the child's condition, they declined planned surgical exploration and further invasive investigation; this refusal was formally documented in the medical record. The patient improved promptly with the intensified conservative regimen, became afebrile within 48 hours, and showed a marked reduction in CRP. She was discharged on oral linezolid and levofloxacin, recovered uneventfully, and had no recurrence at follow-up. Conclusion: Early sonographic assessment and escalation of antimicrobial therapy to cover suspected MRSA and anaerobes may support conservative management when serial imaging shows no organised, drainable abscess.