Sex: M
Vaccine: FLUX, MMR
Symptoms: Amylase increased, Blood culture negative, Blood sodium decreased, Computerised tomogram abnormal, Cough
Clinical narrative: Initial unsolicited report received from the literature on 17-May-2017. Verbatim of the article: Background: Since the induction of the measles, mumps, and rubella (MMR) vaccine, several viruses other than mumps have been reported to cause acute non-suppurative parotitis. In this case, we describe an elderly male with influenza A presenting with acute parotitis. This case involves an 82-year-old male patient, who was vaccinated with INFLUENZA VACCINE and MEASLES, MUMPS AND RUBELLA VACCINE (MMR) (batch number, expiry date, route, dose and site of administration was not reported for both vaccines) on an unknown date. Past medical history was significant for paroxysmal atrial fibrillation, hypertension and severe calcific aortic valve stenosis, status post replacement with a tissue valve. Patient's concomitant medication was not reported. On an unknown date, after the vaccination, patient had cough, myalgias and sore throat and after three days of these symptoms, patient presented to primary care (hospitalized). Patient was treated empirically with azithromycin. On an unknown date, after the vaccination (next day of primary care attendance), patient presented with new left cheek swelling. On an unknown date, after the vaccination, patient was febrile at 39 degree C and an enlarged left parotid gland without palpable fluctuance, revealed on head examination, Stensen's duct was hyperemic but without purulent discharge. On an unknown date, after the vaccination, patient also had an enlarged enhancing left parotid gland consistent with parotitis with inflammatory changes in surrounding soft tissues without cervical lymphadenopathy, focal fluid collections, masses, or obstructing lesion or sialolith in the parotid duct revealed on CT scan. On an unknown date, after the vaccination, nasopharyngeal swab was positive for influenza A as. Patient had no tachypnea, appeared volume-replete and well-nourished. There was no leukocytosis. Patient's heart rate was 102 and other laboratory tests were within normal limits except for sodium 131 mmol/L and amylase 615 U/L. Other viral tests (influenza B, Respiratory Syncytial Virus) and blood cultures were negative. The patient was discharged on amoxicillin/clavulanic acid medication. On an unknown date, the parotitis resolved in 5 days without sequelae. Outcome of the other events were not reported. On an unknown date, patient was discharged. Reporter cannot conclude from PCR data alone that the parotitis was caused by influenza A, lack of neutrophilia, lack of response to initial antibiotics and non suppurative radiologic picture suggest this was likely not a bacterial parotitis. In the literature the association of influenza with parotitis was uncommon and limited to case reports in younger patients. List of documents held by sender: none. Sender's Comments: Sanofi company comment dated 24-May-2017: Patient was vaccinated with influenza vaccine (Unknown manufacturer) and presented, cough, myalgia, sore throat, parotitis and parotid swelling and was diagnosed with influenza A infection. As with any other influenza vaccine may not protect 100% of individuals. Time to onset compatibility is unknown. Additional information regarding patient immune status, any contact to infected person, past vaccination and its tolerance are needed to further assess the case. Based on available information the role of vaccine cannot be ruled out.