Recurrent Unilateral Parotitis: Causes and Next Steps - Internal Medicine

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Recurrent unilateral parotitis, or inflammation of the parotid gland on one side, can be a perplexing condition, especially when common causes such as salivary stones have been ruled out. Given your history of 5-6 episodes of unilateral parotitis in the past six months, along with symptoms of dry eyes and dry mouth, it is understandable that you are seeking further insight into potential causes and next steps for management.

One of the primary considerations in recurrent unilateral parotitis is the possibility of infectious agents. While viral infections, such as mumps, are well-known causes of parotitis, they are less common in vaccinated populations. Bacterial infections, particularly those caused by Staphylococcus aureus or other pathogens, can also lead to recurrent episodes, especially if there is a history of ductal obstruction or reduced salivary flow. It may be beneficial to consult with an infectious disease specialist to evaluate for atypical infections that may not be immediately apparent.

Another potential cause to consider is autoimmune conditions, even though your negative serological tests for rheumatoid factor (RF), antinuclear antibodies (ANA), and anti-SSA/SSB antibodies make classic Sjögren's syndrome less likely. However, there are other autoimmune conditions that can cause unilateral glandular swelling, such as sarcoidosis or even localized forms of autoimmune sialadenitis. A rheumatologist may provide further insights into these possibilities.

Additionally, anatomical issues such as ductal strictures or anatomical variations could predispose the parotid gland to inflammation. Imaging studies, including MRI or ultrasound, may help visualize the gland and its ducts more clearly than a CT scan, potentially revealing structural abnormalities that could contribute to recurrent inflammation.

If you experience another episode of parotitis, it would be prudent to return to your primary care physician or an ear, nose, and throat (ENT) specialist. They can perform a thorough examination and may recommend further imaging studies or laboratory tests to identify any underlying issues. In some cases, a biopsy of the gland may be warranted to rule out neoplastic processes or other chronic inflammatory conditions.

In terms of management, supportive care is essential during acute episodes. This may include hydration, warm compresses to the affected area, and analgesics for pain relief. If a bacterial infection is suspected, antibiotics may be indicated. Furthermore, maintaining good oral hygiene and stimulating salivary flow through hydration and sialogogues (substances that stimulate saliva production) can help reduce the frequency of episodes.

In summary, recurrent unilateral parotitis can stem from various causes, including infections, anatomical abnormalities, and autoimmune conditions. A multidisciplinary approach involving ENT specialists, infectious disease experts, and rheumatologists may be necessary to arrive at a definitive diagnosis and appropriate management plan. If symptoms recur, seeking prompt medical attention will be crucial in addressing the underlying issues effectively.