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We read with interest the recent article on this
subject(1). We have also seen three such cases over a span of three
years. All of them were boys between 4 and 6 years and presented with
recurrent episodes of parotid swelling. They were bilateral in two and
unilateral in one. Associated fever and mild discomfort were reported by
all of them. The swellings had subsided within two weeks either
spontaneously or with use of antibiotics or anti inflammatory agents.
Investigations done were routine and ultrasound of the parotid glands
done in one of them showed heterogenous echotexture with the presence of
anechoic cystic areas. Advanced investiga-tions were limited because of
financial constraints and availability. Considering the benign nature of
this condition, the thera-peutic approach was conservative and the
parents were given favorable prognosis(2). Although, we could not report
these cases because of incomplete work up, yet we would like to share
certain additional facts which we came across while reviewing the
literature on the subject.
The immunologic abnormalities asso-ciated with
recurrent parotitis, besides HIV and phagocytic dysfunction includes
isolated IgG3 subclass deficiency(3) and this will not be identified by
serum immunoelectro-phoresis alone.
Juvenile recurrent parotitis may be familial with
autosomal dominant inherit-ance(4). It has even been reported in
monozygotic twins. In juvenile onset primary Sjogren syndrome (pSS),
parotid swelling may be the only manifestation at onset in 60% of cases,
whereas the rest may have ocular or extraglandular manifestations. The
only way to differentiate it from recurrent parotitis in children is by
the absence of autoantibodies, specifically ANA and anti SSA which are
always positive in the former. The importance of establishing diagnosis
lies in the fact that it requires treatment with low dose steroids or
hydroxychloroquin(5).
Although, parotid sialogram is a hallmark in the
diagnosis of juvenile recurrent parotitis yet the invasive nature and
the difficulties encountered in the conventional sialography has led to
the development of newer diag-nostic modalities such as ultrasound, CT
and MR sialography. MR sialography does not require any contrast medium.
It primarily images liquid structures and the flow can be adequately
demonstrated after stimulation with ascorbic acid. These special
features of MR sialography allow its use also during acute episode of
sialadenitis. Furthermore, no overlapping occurs as in conventional
summation images due to multiplanar reconstruction features but the cost
is prohibitive in many such cases(6).
Bhavneet Bharti,
Veena R. Parmar,
Department of Pediatrics,
Government Medical College and Hospital,
Sector 32, Chandigarh, India.
E-mail: [email protected]
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Jain V, Mani NBS, Singh M, Kumar L. Juvenile
recurrent parotitis. Indian Pediatr 2000; 37: 1126-1129.
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Chitra VV, Premchandra DJ. Recurrent parotitis.
Arch Dis Child 1997; 77: 359-363.
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Marasman WA, Sukhai RN, Recurrent paro-titis and
isolated IgG3 subclass deficiency. Eur J Pediatr 1999; 158: 684.
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Reid E, Douglas F, Crow Y, Hallman A, Gibbson J.
Autosomal dominant juvenile recurrent parotitis. J Med Genet 1998; 35:
417-419.
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Ostuni PA, Ianiello A, Sfriso P, Mazzolo G,
Andretta Gambari PF. Juvenile onset of primary Sjogren’s syndrome:
Report of 10 cases. Clin Exp Rheumatol 1996; 14: 689-693.
- Menauer F. Jager L, Leunig A, Grevers G. Role of diagnostic
imaging in chronic recur-rent parotitis in childhood. Laryngootologie
1999; 78: 497-499.
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