A rare duo: bacterial parotitis and CMV in a neonate – Case report and diagnostic challenges

INTRODUCTION Infections involving salivary glands in newborns, especially when affecting the parotid gland, are uncommon but can arise from secretory stasis and bacterial superinfection, typically caused by Staphylococcus aureus or Streptococcus species. The main risk factors include dehydration, prematurity and immunodeficiency. Clinical manifestations commonly involve swelling, tenderness and purulent discharge. Management generally consists of intravenous antibiotics with surgical intervention reserved for complications. Ultrasound plays a critical role in diagnosis and management of the disease, especially when there is no purulent material from Stensen's duct available for analysis. Early recognition and appropriate treatment are crucial for preventing severe outcomes in these cases. CASE REPORT We report a case of a 7-day-old full-term, breastfed girl admitted with right preauricular swelling and poor feeding. Born without complications, her symptoms also included irritability and purulent discharge from the right Stensen’s duct. Lab tests showed elevated white blood cells and neutrophilia, and ultrasound confirmed an enlarged right parotid gland with an abscess. Empirical antibiotics, clindamycin and cefotaxime, were initiated. Cultures identified Staphylococcus aureus in both the Stensen’s duct discharge and the mother’s milk. Antibiotics were adjusted to clindamycin and later cefaclor. Further investigations for congenital infections through brain ultrasound revealed cysts and vascular abnormalities, and CMV was diagnosed from urine and salivary samples, despite maternal immunity. The patient responded well to antibiotics, showing reduced swelling and normal feeding. She was discharged after 10 days, fully recovered, with follow-up for CMV ongoing. CONCLUSION In neonates with acute parotitis, especially with neurological signs, CMV should be considered due to its multiorgan involvement and link to immunodeficiency. Adequate imaging and laboratory studies are crucial for early diagnosis, guiding treatment and preventing long-term complications.