A 58-year-old man was admitted to the hospital complaining of a 3-day history of fever, malaise and a painful swelling of the right parotid gland. For 2 days before his admission, he had been taking amoxicillin and metronidazole, as the swelling was thought to be related to dental infection, by his general practitioner. His medical history was unremarkable. The patient did not suffer from any immune or endocrine disease and has not taken any other medication in the past. He did not mention any history of diarrhea, vomiting, abdominal pain, joint pain or joint swelling. He was living in Athens suburbs, working as a civil servant.
As the symptoms seemed to persist, the patient was referred to our Hospital's ENT department for evaluation. At physical examination, a firm mass was palpable at the right parotid, and the patient was admitted for further investigation. No evidence of palpable regional lymph nodes was noted and no other clinical findings could be revealed. The chest X-ray showed no abnormalities. His white blood count was 9,250/mm3 (69.7% neutrophils, 17.2% lymphocytes, and 6.8% monocytes), haematocrit 48.5%, haemoglobin level 16.1 g/dl, platelet count 267,000/mm3, C - reactive protein 8.3 mg/dl (normal values up to 0.5 mg/dl) and erythrocyte sedimentation rate 70 mmHg/1st hour. A CT scan of the face was performed (Figure).
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