5

CASE 5


A 7-year-old girl presented with a 2-day history of fever, headache, earache, and swelling and tenderness at the parotid and submaxillary areas. She also found it difficult to open her jaws (to talk, eat, or swallow).


The child had been in good health. However, she received only one dose of the usual childhood vaccinations because the family had moved when she was four months old and she was lost to follow-up.



PHYSICAL EXAMINATION



VS: T 39.6°C

PE: Examination revealed enlargement of the parotid glands (lymphedema of the neck and upward displacement of ears); redness and swelling at the opening of the Wharton duct were also noted.


LABORATORY STUDIES



Blood



WBC: 4300/μL (leukopenia)

Differential: 71% lymphs (lymphocytosis), 9% monos

Serum chemistries: Serum amylase 300 U/L


Imaging



Chest x-ray: Not done (not indicated)


Diagnostic Work-Up


Table 5-1 lists the likely causes of illness (differential diagnosis). A swollen parotid gland, fever, and a negative history of immunization in a child has a limited differential diagnosis. If necessary, the diagnosis can be confirmed by virus culture or serology.


TABLE 5-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Coxsackievirus

Influenza virus

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 5

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