Streptococcus pneumoniae as a Potential Cause of Pyogenic Parotitis in a Patient with Poor Oral Hygiene and Vitamin D Deficiency

Abstract

We report an unusual case of recurrent parotitis caused by Streptococcus pneumoniae in a 23-year-old female university student with poor oral hygiene and vitamin D insufficiency. Despite multiple antibiotic courses, symptoms persisted, highlighting the complexity of diagnosis and management in such cases. Diagnostic workup included blood tests, which showed normal inflammatory markers, and magnetic resonance sialography, revealing two intraductal stones in the right parotid gland. Microbiological culture of purulent discharge from the parotid duct identified S. pneumoniae. The patient was successfully treated with levofloxacin, guided by culture sensitivity, along with parotid massage and hydration. Pneumococcal vaccination was recommended as a preventive measure, with no reported side effects after the first dose. This case underscores the importance of considering S. pneumoniae, an uncommon pathogen in immunocompetent adults, as a potential cause of parotitis. It emphasises the role of comprehensive diagnostics, including imaging and microbiology, in managing recurrent parotitis, especially when typical treatments fail. The case also highlights the potential interplay between oral hygiene, vitamin D status, and susceptibility to unusual pathogens in parotid infections.

Keywords: Magnatic saliogram; Pain; Parotitis; Streptococcus pneumoniae; Vaccination; Vitamin D.

Fig. 1

a MR Saliogram revealing hyperintense right parotid gland. No clear abscess formation in imaging. b Intraductal stones

Fig. 2

Culture of the parotid duct and sensitivity results. S = sensitive; R = resistant; and I = Intermediate: Susceptible, increased drug exposure