SHM Converge Scientific Abstract ePoster Gallery-A Mouth-Watering Case of a Swollen Neck: An Atypical Case of Acute Bilateral Sialadenitis

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This case describes a 23-year-old woman with ulcerative colitis who developed sudden, rapidly progressive bilateral swelling of the lower face and neck while hospitalized. Her recent treatment included infliximab and mercaptopurine after an ulcerative colitis flare. On exam, she had symmetric submandibular swelling without purulence, respiratory distress, or obvious salivary duct obstruction. Labs showed mild leukocytosis, but BMP and IgG4 were normal. CT imaging demonstrated bilateral submandibular sialadenitis with secondary cellulitis of the floor of the mouth, along with pharyngeal and laryngeal edema, but no lymphadenopathy. Flexible nasopharyngolaryngoscopy showed no mass or lesion, only mild pharyngeal edema and thick secretions.<br /><br />She was treated with IV cefepime and dexamethasone, encouraged to use sialagogues, and closely monitored for airway compromise. Her symptoms resolved completely within 48 hours.<br /><br />The presentation highlights the differential diagnosis of acute bilateral, non-purulent, non-obstructive sialadenitis. While most sialadenitis is unilateral and due to sialolithiasis, acute bilateral cases may also reflect infection, autoimmune disease, malignancy, or medication-induced inflammation. Increasing evidence suggests that “idiopathic” cases may actually be drug related, particularly with immunomodulators and chemotherapeutic agents. Proposed mechanisms include direct toxicity, latent viral reactivation, or immune dysregulation.<br /><br />The key clinical lesson is that a detailed medication review is essential when evaluating acute sialadenitis. Early recognition of a drug-induced cause can prevent unnecessary testing and treatment and may allow prompt discontinuation of the offending medication.

Asset Subtitle

Aaron Fried

Meta Tag

Author List Aaron Fried, Courtney E. Detwiler, Evan Raff, Nicholas Piazza

Category Clinical Vignettes

Concept Sialadenitis

Concept Medication Review

Concept Medication Side Effect

Concept Inciting Factor

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization University of North Carolina at Chapel Hill

Presenting Author Aaron Fried

Track Adult

Keywords

ulcerative colitis

bilateral sialadenitis

submandibular swelling

drug-induced inflammation

infliximab

mercaptopurine

floor of mouth cellulitis

laryngeal edema

airway monitoring

medication review

Sialadenitis

Medication Review

Medication Side Effect

Inciting Factor

Differential Diagnosis