Acute parotitis in a 4-year-old in association with COVID-19.

An otherwise healthy 4‐year‐old boy presented with a day of malaise, diarrhoea, vomiting and mild abdominal pain. He had a history of asthma for which he had been taking montelukast for a year. He was up to date with his immunisations, including the measles–mumps–rubella vaccine. One day earlier, his parents were diagnosed with COVID‐19 disease by reverse transcription‐polymerase chain reaction assays on respiratory specimens. At presentation, the boy was haemodynamically stable with a completely normal physical examination. A combined oropharyngeal and nasopharyngeal swab was positive for SARS‐CoV‐2 by reverse transcription‐polymerase chain reaction. He was not admitted.

Four days later, however, the child was admitted to our tertiary hospital with right‐sided facial swelling and pain, especially in the pre‐auricular area and cheek, with difficulty swallowing. The swelling measured 2 × 2 cm, extended from the pre‐auricular region to the mandible and was soft and non‐fluctuant (Fig. 1). There was no purulent discharge after the parotid massage. Other systems examinations were normal.

Fig 1

(a,b) Photos of the child with parotitis associated with COVID‐19. There was a 2 × 2 cm soft, non‐fluctuant swelling extending from the pre‐auricular region to the angle of the mandible.

Laboratory tests results showed a total white cell count of 3.6 × 109/L and neutrophil count 1.3 × 109/L. Liver and kidney function tests were normal. Serum amylase was 147 U/L (normal 28–100). Serology was negative for mumps, measles, rubella, hepatitis A, hepatitis C, Cytomegalovirus, Epstein‐Barr virus and human immunodeficiency virus. Neck ultrasonography showed diffuse, hypoechoic enlargement of the parotid gland, compatible with acute parotitis. No pathological lymphadenopathy was detected. The patient was treated with a non‐steroidal anti‐inflammatory. At follow‐up, 3 days later, his facial swelling had resolved.

Acute parotitis has been reported in association with COVID‐19 in adults. , , , , The most common cause of acute parotitis in childhood is mumps, which is usually bilateral. Other infections which can cause parotitis include rubella, coxsackievirus, influenza, herpesviruses and human immunodeficiency virus. Non‐infectious causes include recurrent parotitis of childhood, which may have an auto‐immune basis.

The adult cases of COVID‐19‐associated parotitis were usually unilateral and clinically similar to our case, with onset mostly 1–3 days after commencement of COVID‐19 symptoms. , , , , Cases of COVID‐19‐associated parotitis in children are rare. In a case series of 15 patients with COVID‐19‐associated parotitis, only 2 were children (10 and 13 years old). Our case is the youngest child reported with parotitis associated with COVID‐19 to our knowledge.

Permission was obtained from family and patient to use the patient's picture.