Drug-induced parotitis

Doxorubicin and cyclophosphamide-induced parotitis: A case report

WHAT IS KNOWN AND OBJECTIVE

Drug-induced parotitis is a rare adverse drug reaction (ADR). A comprehensive literature review identified only three clearly associated medications: L-asparaginase, clozapine and phenylbutazone.

CASE DESCRIPTION

We describe a novel case of drug-induced parotitis attributed to doxorubicin and cyclophosphamide chemotherapy for breast cancer.

WHAT IS NEW AND CONCLUSION

Using general and parotitis-specific tools for assessing the probability of an ADR, we estimate the association of doxorubicin and cyclophosphamide with parotitis in this case as 'probable'. To our knowledge, this represents the first reported case of parotitis attributable to these medications and provides a valuable learning tool for the assessment of previously unrecognized ADRs.

[Bilateral parotitis in a patient under continuous positive airway pressure treatment]

BACKGROUND AND OBJECTIVES

Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit.

CASE REPORT

A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications.

CONCLUSIONS

Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

Nifedipine-induced histological changes in the parotid glands of hypertensive rats

Nifedipine is a widely used anti-anginal and anti-hypertensive agent. It is associated with significant gingival changes attributed more to collagen hyperplasia than to enhancement of protein synthesis. We investigated the influence of nifedipine on morphological changes in the parotid glands of rats in a model of hypertension. Twenty-eight male Wistar rats (8-10 weeks; 200±15 g) were divided into four groups (A-D). Hypertension was induced by surgical means in groups C and D. Animals in groups B and D were treated with nifedipine (0.85 mg/kg) via a gastroesophageal catheter the day after surgery (experimental day-1) for 2 weeks. A significant difference was observed between the control group and nifedipine group and between the control group and hypertension group with regard to the weight of the parotid gland and its surface area. Histological findings demonstrated changes in the parotid glands of hypertensive animals with mild vessel dilatation and infiltration of inflammatory cells. These histological findings seemed to be due more to changes in venous function than to alterations in gland architecture.

Bilateral parotitis in a patient under continuous positive airway pressure treatment

BACKGROUND AND OBJECTIVES

Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit.

CASE REPORT

A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications.

CONCLUSIONS

Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

Neonatal inflammatory submandibular sialadenitis associated with prenatal methyldopa exposure

Inflammation of a salivary gland is an uncommon condition in the neonatal period, and an isolated form of submandibular acute inflammatory sialadenitis is an exceptionally rare phenomenon. Among various conditions that might lead to submandibular acute inflammatory sialadenitis, maternal use of drugs during pregnancy should be questioned as there may be possible associations. Herein, we describe a late preterm infant who presented with a large submandibular mass. After excluding possible pathogenic causes, maternal use of methyldopa was believed to be the only factor associated with this condition. To the best of our knowledge, no such relationship has been documented in previously published literature.

A review and assessment of drug-induced parotitis

OBJECTIVE

To review the current literature on drug-induced parotitis.

DATA SOURCES

Literature was accessed through MEDLINE/PubMed (1980-May 2012), using the search terms sialadenitis/chemically induced and parotitis/chemically induced. EMBASE (1980-May 2012) was searched using the terms parotitis/diagnosis, sialadenitis/side effect, and parotitis/side effect. International Pharmaceutical Abstracts (1970-May 2012) was searched using the search terms parotitis and sialadenitis. All searches were limited to articles on humans written in English. Inclusion criteria were published letters, case reports, reviews, and clinical trials involving drugs that may be associated with parotitis. Articles pertaining to parotitis induced by iodine-containing drugs were excluded. References of all relevant articles were reviewed for additional citations.

STUDY SELECTION AND DATA EXTRACTION

Review articles, clinical trials, background data, and case reports of drug-induced parotitis were collected and case reports were assessed for causality.

DATA SYNTHESIS

Parotitis is an uncommon adverse effect; however, signs and symptoms of parotitis have been noted in case reports as an adverse drug reaction related to various medications. Assessing causality of an adverse drug reaction such as parotitis is challenging. To help determine the probability of causality for these events, algorithms such as the Naranjo probability scale have been developed. Eighty-four case reports of drug-induced parotitis from 40 different drugs were reviewed using a modified Naranjo probability scale that included criteria specific for parotitis. Medications that met the criteria for establishing causality included l-asparaginase with 7 case reports, clozapine with 13 case reports, and phenylbutazone with 13 case reports.

CONCLUSIONS

Drug-induced parotitis is a rare adverse drug reaction. Based on the quantitative and qualitative evidence collected from the case reports, medications that are associated with drug-induced parotitis include l-asparaginase, clozapine, and phenylbutazone. Many other drugs have been implicated in the development of parotitis; however, the evidence supporting this association is insufficient to determine causality at this time.

Acute parotitis induced by trimethoprim/sulfamethoxazole

Adverse drug reactions to the sulfonamide antibiotics are uncommon. When they do occur, they usually manifest as a rash or urticaria. Our review of the recent literature found that while sialadenitis is listed as a possible side effect of sulfonamide use, no actual case has ever been reported until now. We describe a case of acute bilateral parotitis that arose as a side effect of sulfonamide antibiotic treatment. We also examine the relevance of such pathology to the proposed mechanisms of sialadenitis, and we briefly discuss sulfonamide-induced pancreatitis. Lastly, we review the controversy over the possibility that some adverse drug reactions may be caused by cross-reactivity among different classes of sulfonamides.

Concurrence of Stevens-Johnson Syndrome and Bilateral Parotitis after Minocycline Therapy

Minocycline is an antibiotic of tetracycline derivatives that is commonly used in the treatment of moderate to severe acne vulgaris. It has been reported to cause rare adverse events from mild cutaneous eruption to severe forms including drug-induced lupus, serum sickness-like reaction, and hypersensitivity reactions, etc. The risks of adverse events attributed to minocycline have not been ascertained reliably and there are concerns about the safety of minocycline which could possibly result in life-threatening events such as the Stevens-Johnson syndrome. Here we demonstrate an unusual case of Stevens-Johnson syndrome in conjunction with bilateral parotitis after the intake of minocycline in a Korean boy suggesting discreet use of the drug.

Severe sialadenitis: A new complication of drug reaction with eosinophilia and systemic symptoms

BACKGROUND

Drug cutaneous reaction and isolated cases of parotitis induced by terbinafine have been reported.

OBSERVATION

We report a case of drug reaction with eosinophilia and systemic symptoms induced by terbinafine associated with a severe sialadenitis and a complete sicca syndrome. Evolution was protracted with a slow recovery of the rash but sicca syndrome persisted with only a very mild improvement at 6 months.

CONCLUSION

Liver, kidneys, lungs, and heart are the organs the most frequently involved in drug reaction with eosinophilia and systemic symptoms. Salivary and lacrimal glands can also be severely involved in the course of drug reaction with eosinophilia and systemic symptoms.

Morphological changes of parotid glands following adjuvant arthritis and ibuprofen treatment in rats

Drug administration and numerous systemic diseases may cause morphological changes of the parotid gland. The aim of this study was to investigate the possible relationship between experimental adjuvant arthritis following ibuprofen treatment and morphological alterations of the parotid glands in rats. Freud's adjuvant was injected intradermally into the plantar surface of the hind paw of the animals to induce experimental arthritis. Ibuprofen was administrated per os (17 mg/kg/day). Both adrenals and parotid glands were isolated and their absolute and relative weights were evaluated. A full histological examination of parotid glands took place. The diameter of the foot as well as the serum levels of rheumatoid factor was measured. In conclusion, both experimental adjuvant arthritis and ibuprofen treatment induce morphological changes of the parotid tissues, which are related to macro- and micro-structure of the gland.

Pseudo-Primary Infection Syndrome following Discontinuation of Antiretroviral Therapy

We report the case of a retroviral rebound syndrome associated with parotid gland enlargement in a chronically HIV-infected man.

Sulfadiazine-induced sialadenitis

OBJECTIVE

To present a case of sialadenitis induced by sulfadiazine.

CASE SUMMARY

A 50-year-old man with bronchitis developed swelling of the parotid glands and floor of the mouth as well as plugging in his ears 2 hours after ingestion of Bronco-aseptilex (sulfadiazine, cyclamate, and guaiacol). Skin-prick tests performed with serial dilutions of sulfadiazine and Bronco-aseptilex were all negative. We then performed oral challenge tests with Bronco-aseptilex, sulfadiazine, and other compounds of the commercial syrup. Enlargement of the salivary glands was observed after oral challenge tests with Bronco-aseptilex and sulfadiazine.

CONCLUSIONS

We describe a patient who developed drug-induced sialadenitis. The oral challenge test confirmed that sulfadiazine was the etiologic agent.