Recognition and management of acute suppurative parotitis

Acute suppurative parotitis (ASP) is a rare infectious process occurring after surgery or in debilitated patients. This case describes a 41-year-old man who was hospitalized initially for acute bacterial endocarditis. Late in the hospital course his recovery was complicated by the development of ASP. Subsequent cultures of blood and parotid-fluid samples grew Pseudomonas aeruginosa. Despite early empiric antibiotic therapy followed by more specific therapy with an aminoglycoside, the patient continued to experience severe pain, swelling, and facial-nerve palsy. Surgical incision and drainage of the parotid gland was accomplished on the ninth day after onset of ASP, and the patient experienced a rapid resolution of the disease process. Acute suppurative parotitis was originally attributed to infection with gram-positive organisms, primarily Staphylococcus aureus and Streptococcus species. More recently, reports of ASP caused by gram-negative and anaerobic bacteria have been published. This review describes the etiology, pathogenesis, microbiology, and clinical features of ASP. Nonpharmacologic, pharmacologic, and surgical management of the disease is discussed. Although ASP is a rare occurrence in the hospital setting, early recognition and appropriate management are important in avoiding serious morbidity and mortality.