Case by Kala Frye Bourque MD, CNH PEM Fellow

A 6-year-old male presents to the ED with pain and swelling to the left neck that started this morning. His symptoms began with pain in the left gums the prior evening, with swelling noted after awakening. He denies fevers, chest pain, shortness of breath, or drooling.

Pertinent history includes: 
– Recent recovery from a cold 1-2 weeks ago, persistent congestion without fever. 
– Seasonal allergies managed with Zyrtec (last taken last night). 
– No known sick contacts, recent travel outside the area, or pet exposures (except visiting a home with a cat 2 weeks ago). 
– Patient is unvaccinated

Vitals: Temp 36.7°C, HR 88, RR 18, BP 97/78, SpO₂ 99%, weight 24.8 kg

General: Alert, interactive, appropriate for age. 
Neck: Soft, tender swelling (~10 cm) over left lateral face/neck, spanning the mandible. No palpable masses or tracheal deviation. 
ENT: Left tonsillar swelling without uvular deviation. No drooling or hot potato voice. 
Respiratory: Clear breath sounds, non-labored breathing. 
Neurological: No focal deficits, normal motor/sensory exams. 

US Soft Tissue is performed: The ultrasound showed an enlarged, edematous, and hyperemic left parotid gland with a normal right parotid gland and tonsils.

Given the patient’s unilateral parotid swelling, recent viral illness, and unvaccinated status, mumps is high on the differential. Mumps IgM/IgG testing was sent. Viral parotitis from another etiology remains a possibility, and most likely though, given patient is otherwise healthy.