|Year : 2017 | Volume
| Issue : 2 | Page : 74-76
Hyperacute bilateral parotitis: An unusual manifestation of iodide mumps
S Sulaiman, GN Rajesh, H Vellani
Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
|Date of Web Publication||20-Jun-2017|
Department of Cardiology, Government Medical College, Kozhikode - 673 008, Kerala
Source of Support: None, Conflict of Interest: None
We report a case of hyperacute bilateral parotitis, where the patient developed bilateral parotid swelling within minutes, following administration of low-osmolar iodinated contrast agent. The condition, often called “iodide mumps” usually has a late onset ranging from hours to days. Recognition of early onset of the condition is important to avoid unnecessary investigations as the condition usually follows a benign course.
Keywords: Contrast hypersensitivity, hyperacute bilateral parotitis, iodide mumps
|How to cite this article:|
Sulaiman S, Rajesh G N, Vellani H. Hyperacute bilateral parotitis: An unusual manifestation of iodide mumps. Heart India 2017;5:74-6
| Introduction|| |
Iodinated contrast media are widely used in interventional procedures. Apart from anaphylactoid reactions, these agents may also cause idiosyncratic reactions. Contrast-induced sialadenitis, commonly known as iodide mumps, involves swelling of the salivary glands after exposure to iodinated contrast. This is usually self-resolving and interventionalists should be aware of the condition, especially while performing procedures involving neck vessels as in our case.
| Case Report|| |
A 68-year-old man with history of long-standing hypertension presented with complaints of recurrent episodes of transient ischemic attack, in the form of amaurosis fugax. On examination, the patient had a left carotid bruit, and carotid Doppler revealed 80% stenosis of the left internal carotid artery (ICA). Elective angioplasty and stenting of carotid were planned. The patient had normal baseline renal function. He had no history of allergies and had not received iodide containing contrast previously. Angiogram revealed significant stenosis of common carotid bifurcation involving the ostium and proximal segment of ICA [Figure 1]a. The procedure was completed uneventfully with stenting of left internal carotid artery [Figure 1]b using 100 ml of nonionic low-osmolar iodinated contrast (iohexol 300 mg/ml). However, within 5 min of completion of the procedure, while still on the operating table, the patient developed painless swelling of both parotids [Figure 2]a and [Figure 2]b. There were no associated symptoms of dryness of mouth, respiratory difficulty, nausea, vomiting, or urticaria. The parotids were firm and nontender to palpation. Examination of the oral cavity was normal. His vitals were stable. A diagnosis of iodide mumps was made. The patient was monitored closely for the progression/development of new symptoms. The swelling significantly reduced within 12 h. The patient was discharged after 72 h with no residual swelling.
|Figure 1: (a) carotid angiogram showing significant stenosis of distal common carotid and proximal internal carotid artery. (b) Postcarotid angioplasty showing restoration of blood flow|
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|Figure 2: (a) Image showing swollen left parotid (arrow) about 5 min after carotid stenting. (b) Image showing swollen right parotid (arrow) 5 min after carotid stenting|
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| Discussion|| |
Iodide mumps is an uncommon condition, considering the widespread usage of iodinated contrast media in diagnostics and interventions. No case of sialadenitis were reported in a related large-scale study. However, there have been several case reports, and a literature review found that submandibular salivary glands are more often involved than parotids. The condition can occur following administration of any type of iodinated contrast agent (ionic or nonionic), by any route. In almost all of the reported cases, the onset of parotid swelling was noted a few hours to days following contrast exposure. In one report, the patient developed parotitis with facial paralysis after 30 min. In our case, the parotid swelling developed within 5 min of completion of the procedure, before the patient was shifted out of the operating room. Painful swelling is less common, reported by about 25% of patients. Life-threatening complications are never reported. No difference in the clinical course has been noted based on the time of onset of sialadenitis. Bilateral parotitis following carotid stenting has been reported before, but the symptoms developed several hours after the procedure. The mechanism of contrast-induced sialadenitis is not completely known. The various suggested mechanisms include an idiosyncratic reaction, toxic accumulation of iodide in the salivary glandular ducts, renal failure leading to iodide intoxication of salivary glands causing inflammatory swelling. However, it was shown more convincingly that the condition represents a noninflammatory swelling of the salivary glands induced by iodine. Although patients with renal failure may be at higher risk, those with normal renal status are not immune to the condition. Similarly, neither the osmolality nor the amount of contrast used seems to have a role. Steroids and antihistamines have been tried in some cases, but their role has not been systematically studied. Symptomatic management and watchful waiting are best done as complete self-resolution is the rule in most of the cases.
| Conclusion|| |
Iodide mumps is often reported as a late reaction to iodine-containing contrast media. Our case illustrates the early and rapid onset of the condition. Radiologists and interventionalists need to be aware of this manifestation of iodide mumps to avoid unnecessary alarming. The early onset may not portend a severe course or poor prognosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]