A 14-month-old child first presented to medical care at an outside hospital for swelling of the right parotid, without any other signs or symptoms. The swelling was noted by parents 1 month before, becoming more evident during the last 10 days. Past clinical and family histories were unremarkable.
Examination
Clinical examination revealed the presence of hard, painless swelling in the right parotid area, a palpable bilateral cervical lymphadenopathy (more evident on the right side of the neck), and a mild upper respiratory tract infection. The palpable lymph nodes were described as mobile and painless, having a maximum diameter of approximately 2 centimetres. First-line blood tests were negative, with no increase in C-reactive protein (CRP) or leucocytosis. Mononuclear spot test for Epstein - Barr virus (EBV) and other serological blood tests allowed us to exclude ongoing infections. The right parotid gland’s ultrasonography (US) showed cystic and solid nodular lesions with diameters between 6.5 mm and 24.6 mm. Similar formations were also noted within the left parotid, although of smaller dimensions. Bilateral cervical lymphadenopathy was confirmed by ultrasound, especially on the right side of the neck, with a maximum lymph node diameter of 15 mm.
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