Intraglandular toxoplasmosis of the parotid gland pre- or postoperative diagnosis?

Toxoplasmic Lymphadenitis of the Head and Neck Region

OBJECTIVE

We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery.

METHODS

A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled.

RESULTS

All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period.

CONCLUSIONS

It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Intraglandular toxoplasmic lymphadenitis of the parotid gland

Most preauricular masses are parotid neoplasms; however, some infectious and inflammatory causes may exhibit similar presentation. Toxoplasmosis is a worldwide parasitary disease. The clinical presentation of toxoplasmosis is mostly asymptomatic and may include subfebrile fever, fatigue, and lymphadenopathy. Only 13 clinical reports of intraglandular toxoplasmic lymphadenitis have been previously reported in the English literature. A careful history and examination with appropriate investigations, including immunoglobulin G avidity assay, will frequently provide the diagnosis of intraparotid toxoplasmosis. Surgery might therefore have been delayed or avoided depending on a satisfactory clinical improvement in consequence of proper medical treatment.