A 17-year-old boy is brought to the clinic due to fever and facial pain. Two days ago, fever, myalgias, and fatigue began. This morning, pain and fullness developed in the right cheek. The patient has no chronic medical conditions and takes no daily medications. Immunizations are not up to date, but the family cannot remember which ones were missed. The patient is in high school and is on the school track team. He has a girlfriend but is not sexually active. He does not drink, smoke, or use illicit drugs. Temperature is 38.3 C (100.9 F). Examination reveals an alert, uncomfortable-appearing adolescent. Tenderness and fullness are present in the right cheek, which obscures the angle of the mandible. Bilateral tympanic membranes are clear. The oropharynx has no erythema, exudate, or tonsillar enlargement. No cervical lymph nodes are palpable. This patient is at greatest risk for developing which of the following complications?

Question

A 17-year-old boy is brought to the clinic due to fever and facial pain.  Two days ago, fever, myalgias, and fatigue began.  This morning, pain and fullness developed in the right cheek.  The patient has no chronic medical conditions and takes no daily medications.  Immunizations are not up to date, but the family cannot remember which ones were missed.  The patient is in high school and is on the school track team.  He has a girlfriend but is not sexually active.  He does not drink, smoke, or use illicit drugs.  Temperature is 38.3 C (100.9 F).  Examination reveals an alert, uncomfortable-appearing adolescent.  Tenderness and fullness are present in the right cheek, which obscures the angle of the mandible.  Bilateral tympanic membranes are clear.  The oropharynx has no erythema, exudate, or tonsillar enlargement.  No cervical lymph nodes are palpable.  This patient is at greatest risk for developing which of the following complications?

Quizplus · Accepted Answer

11ec25c8_d6c7_ae94_bc81_45f12181fb9e_MD0003_00 This teenager with parotitis following a nonspecific prodrome of fever, myalgias, and fatigue likely has mumps. This contagious viral illness is usually self-limited, but serious complications (due to systemic spread of the virus) are possible. The virus has an affinity for glandular epithelium and classically causes parotitis, which can be unilateral or bilateral. Orchitis, a common complication, can develop in infected adolescent boys and young adults and impair fertility. Pancreatitis has been described in infected children and adults. The virus is neurotropic and can cause aseptic meningitis (generally benign) and sensorineural hearing loss (often transient but can lead to deafness). Immunization against mumps is provided by the measles-mumps-rubella vaccine. Among unvaccinated children, mumps is most common in school-age children, who often have mild disease or are asymptomatic. Symptoms are more severe and complications are more likely among unvaccinated adolescents and adults. Vaccinated patients are more likely to present in late adolescence or early adulthood as immunity wanes. (Choice A) Glomerulonephritis can follow streptococcal pharyngitis or cellulitis. This patient has no signs or symptoms of pharyngitis, and group A Streptococcus is a rare cause of parotitis. (Choice B) Mumps is not associated with hepatitis in immunocompetent patients. (Choice C) Primary infection with HIV can present with parotitis and subsequently lead to CD4⁺ T-cell depletion. This teenager is not sexually active and does not use intravenous drugs, making acute HIV infection extremely unlikely. (Choice D) Myositis, particularly of the calves or thighs, can be a complication of influenza. Influenza presents with fever, myalgias, and pharyngitis, often with lower respiratory tract infection, but is a rare cause of parotitis. (Choice F) Epstein-Barr virus (EBV) can cause mononucleosis, a syndrome that includes fever, pharyngitis, and cervical lymphadenopathy. Mononucleosis can be complicated by splenomegaly and, in severe cases, splenic rupture. EBV is also a common cause of viral parotitis; however, the absence of pharyngitis or cervical adenopathy in this teenager makes EBV infection unlikely. Educational objective: Mumps presents with fever and parotitis. Although mumps is generally self-limited, complications can include orchitis, aseptic meningitis, pancreatitis, and deafness. Complications are more common in older or unvaccinated individuals. References: Mumps. (http://www.ncbi.nlm.nih.gov/pubmed/18342688) Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine. (http://www.ncbi.nlm.nih.gov/pubmed/29317117)

A 17-Year-Old Boy Is Brought to the Clinic Due to Fever