SHM Converge Scientific Abstract ePoster Gallery-Unusual Presentation of Parotid Abscess in a Young Healthy Male

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A healthy 25-year-old man initially presented with a 3-day history of right-sided throat pain, fever, and chills, along with a painful left postauricular swelling that had been present for 4 weeks. Exam showed a right peritonsillar abscess causing uvular deviation and a fluctuant, erythematous left postauricular mass. CT imaging confirmed a right peritonsillar collection and multiple left parotid fluid collections. He was treated with IV clindamycin and underwent incision and drainage of both abscesses, with clinical improvement and negative routine cultures.<br /><br />Eight weeks later, he returned with new left preauricular swelling and trismus. Repeat CT demonstrated a complex multiloculated abscess in the superficial lobe of the left parotid gland. Further history revealed long-term exposure to four cats. Serology showed Bartonella henselae IgG 1:512, and surgical drainage of the parotid abscess yielded thick yellow purulence. Routine cultures remained negative, but PCR from the specimen was positive for Bartonella henselae DNA. He was treated with 14 days of doxycycline and had no recurrence on follow-up.<br /><br />This case highlights cat scratch disease as a rare and often missed cause of head and neck abscesses, especially parotid abscess. It also raises the possibility that the initial peritonsillar abscess may have been related to Bartonella infection. The report emphasizes the importance of obtaining exposure history, especially contact with cats, because empiric treatment and drainage alone may miss the underlying diagnosis and prevent targeted testing and therapy.

Asset Subtitle

Lihua Zou

Meta Tag

Author List Lihua Zou, Rowena Jimenez

Category Clinical Vignettes

Concept Bartonella henselae infection

Concept Exposure History

Concept Cat exposure

Concept Incision and Drainage

Concept Parotid Abscess

Distinguished Non-Finalist

Presenter Organization NE Geisinger IM

Presenting Author Lihua Zou

Track Adult

Keywords

cat scratch disease

Bartonella henselae

parotid abscess

peritonsillar abscess

head and neck abscess

cat exposure

PCR positive

doxycycline treatment

negative cultures

lymphadenitis

Bartonella henselae infection

Exposure History

Cat exposure

Incision and Drainage

Parotid Abscess