An Uncommon Presentation of Enteric Fever with Acute Bilateral Parotitis in a Pediatric Patient
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1416Abstract
Background: Enteric fever, caused by Salmonella enterica serovar Typhi, is a significant infectious disease in endemic regions, typically presenting with prolonged fever and gastrointestinal manifestations. Although extra-intestinal complications are well documented, involvement of the salivary glands is exceedingly rare. Parotitis in children is most commonly viral in origin, particularly due to mumps, and its association with enteric fever remains uncommon and underreported.
Case Presentation: We report the case of a 7-year-old previously healthy boy who presented with a 20-day history of persistent high-grade fever and a 2-day history of painful right-sided parotid swelling, which subsequently progressed to bilateral involvement. The patient had received multiple empirical treatments, including antimalarials and oral antibiotics, without clinical improvement. On examination, he appeared febrile, ill-looking, and had tender right sided parotid enlargement without signs of suppuration. Empirical intravenous ceftriaxone was initiated upon hospital admission.
Results: Laboratory investigations revealed mild anemia, normal leukocyte count, and mildly elevated liver enzymes. Viral serologies, including mumps, dengue, HIV, hepatitis B, and hepatitis C, were negative. Ultrasonography demonstrated bilateral parotid gland enlargement without abscess formation or ductal obstruction. Blood culture yielded extensively drug-resistant (XDR) Salmonella Typhi, sensitive only to azithromycin and meropenem. Following initiation of intravenous meropenem, the patient showed rapid clinical improvement, with complete resolution of fever and marked reduction in parotid swelling within three days.
Conclusion: Parotitis may represent a rare extra-intestinal manifestation of enteric fever, particularly in endemic settings with increasing antimicrobial resistance. Clinicians should maintain a high index of suspicion for enteric fever in children presenting with prolonged fever and atypical features such as parotid swelling to ensure timely diagnosis and appropriate targeted therapy.
Keywords: Antimicrobial resistance, Atypical presentation, Bilateral parotitis, Enteric fever, Pediatric infection, Salmonella Typhi.
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