腮腺肿痛为首发症状的COVID-19报道及文献分析

Report and literature analysis of COVID-19 with parotid swelling and pain as the first symptom

目的报告1例以腮腺肿痛为首发症状的新型冠状病毒感染(COVID-19)患者的诊治经过,为其诊断和治疗提供经验。方法分析1例以“左侧腮腺肿痛2天”为首发症状的76岁男性COVID-19患者的流行病学资料、临床表现、实验室和影像学检查结果、治疗效果,综合分析影响COVID-19患者传染源判断、临床诊断、预后的因素。结果患者左侧腮腺肿大以耳垂为中心,触痛明显,无波动感,局部不发热,颌下淋巴结肿大。白细胞(WBC)总数为5.89×10^(9)/L,嗜酸性粒细胞(eosinophilic granulocyte,EOS)计数为0%。多层螺旋CT(multi-slice spiral CT,MSCT)提示COVID-19。彩超提示左侧腮腺均质性肿大,颌下淋巴结肿大,SARS-CoV-2核酸检测阳性。通过病史和实验室检查排除急性化脓性腮腺炎、流行性腮腺炎、川崎病、药物导致的腮腺肿痛,根据“一元化”原则,诊断为COVID-19。腮腺肿痛为COVID-19所致。经治疗,患者的SARS-CoV-2核酸检测多次阴性,MSCT提示双肺感染病灶部分实变,但EOS计数一直未恢复至正常。结论COVID-19可能以腮腺肿大为首发症状,EOS计数下降(甚至降低为0%)对COVID-19的诊断有提示意义。

Objective To report the diagnosis and treatment process of a case of COVID-19 with parotid swelling and pain as the first symptom,and to provide experience in its diagnosis and treatment.Methods The epidemiological data,clinical manifestations,laboratory and imaging examination results,and therapeutic effect of a 76-year-old male COVID-19 patient with"left parotid swelling and pain for 2 days"as the first symptom were analyzed.The factors affecting the judgment of infection source,clinical diagnosis and prognosis of the COVID-19 patient were comprehensively analyzed.Results The patient′s left parotid gland was swollen with the earlobe as the center,with obvious tenderness,no fluctuation,no local fever,and swollen submandibular lymph nodes.The total number of WBC was 5.89×10^(9)/L,and the eosinophilic granulolyte(EOS)count was 0%.Multi-slice spiral CT(MSCT)suggested COVID-19.Color doppler ultrasound showed homogeneous enlargement of the left parotid gland and enlarged submandibular lymph nodes.The SARS-CoV-2 nucleic acid test was positive.Acute suppurative parotitis,epidemic parotitis,Kawasaki disease and drug-induced parotid swelling and pain were ruled out through medical history and laboratory examination.According to the principle of"unification",COVID-19 was diagnosed.The cause of parotid swelling and pain was COVID-19.After treatment,the patient′s SARS-CoV-2 nucleic acid test was negative for several times,but the EOS count never returned to normal,and MSCT showed partial consolidation of bilateral lung infection lesions.Conclusion COVID-19 can present with parotid welling as the first symptom,and a decrease in EOS count(even reduced to 0%)is suggestive for the diagnosis of COVID-19.