Age: 25.0
Sex: M
Vaccine: MMR
Symptoms: Middle insomnia, Mumps, Neck mass, Neck pain, Pain in jaw
Clinical narrative: Information has been received from the author in a published literature article and refers to a one of the sheet metal operator presented in front of your office complaining of a visible and large left-sided neck mass. The 25 year old staff reporting that last night on an unspecified date, he woke up with a feeling that someone had punched him in the left jaw. He attempted to return to sleep, but soon experienced an intense headache and spent the early morning hours tossing and turning while icing, the left side of his face with frozen vegetables. He reported that he did feel last night with alternating chills, but did not experience any difficulty breathing or swallowing. He also denied any traumatic events this past weekend that might have been responsible for the swelling of the left side of his face. The man believed he knew what was occurring and reported that he had a history of submandibular abscesses, with two in recent years requiring treatment with incision and drainage and intravenous (IV) antibiotic therapy. He showed you a faint scar in his left submandibular region. At this point the patient was guide into the clinic room, place him on the exam table, and obtain vital signs, which were pertinent for an oral temperature of 100.4 degrees (38 degrees) and heart rate of 105. A thorough evaluation of his ears, nose, mouth, and throat produced no abnormal findings.Palpation of his left submandibular and preauricular region confirmed increased swelling when compared to the right side of his face. The patient also reported tenderness with palpation of the left side of his face. The patient was an otherwise healthy 25-year-old man with no pertinent medical or surgical history and he was properly medically out-processed. On an unspecified date, the patient was vaccinated with a dose of M-M-R II (dose, route and lot number not reported). The next day, on an unknown date, the patient returned and presented with worsening neck pain and increased firmness of the left-sided swelling. He reported continuing fevers and chills through the night and overall worse. Fortunately, the facility had a visiting host-nation otolaryngologist who agreed to consult on the patient. He agreed that this was a worsening submandibular abscess and admitted the patient to the hospital for intravenous therapy broad spectrum antibiotics and observation. The patient denied testicular involvement. He continued to experience intermittent fevers and headaches and was having difficulty tolerating a regular diet. After discussion with the hospitalist, the patient continued inpatient care with isolation, provided supportive care but discontinued his IV antibiotics as his clinical presentation was consistent with mumps and IV antibiotics would provide no benefit for treatment. The sheet metal maintainer completed his final days of quarantine in billeting. He was tolerating a regular diet and reported his strength and energy have returned. His most recent physical exam was unremarkable for parotitis. He could return to work. The M-M-R II vaccine has been shown to have 96% protective efficacy. Therefore, about 4% of people who has been vaccinated can still acquire a mumps infection. Additional information has been requested.