Acute Neonatal Parotitis with Late-Onset Septic Shock due to Streptococcus agalactiae

Acute neonatal parotitis (ANP) is a very rare disease. Most cases are managed conservatively; early antibiotics and adequate hydration may reduce the need for surgery. The most common cause of ANP is Staphylococcus aureus. We report a rare case of acute neonatal parotitis with late-onset septic shock due to Streptococcus agalactiae. The diagnosis was confirmed with ultrasound and isolation of Streptococcus agalactiae from blood culture. The patient was treated successfully with 10 days of intravenous antibiotics and supportive measures. Despite being rare, streptococcal ANP should be considered in the etiological diagnosis of neonatal sepsis. Early diagnosis and appropriate antibiotic might prevent serious complications. 1. Introduction Acute neonatal parotitis (ANP) is a rare infection with a prevalence of 3.8/10？000 admissions for neonates [1] and an incidence of 13.8 per 10,000 admissions [2]. Only few cases of ANP are reported in literature and the most predominant pathogen is Staphylococcus aureus [3]. Here, we report a rare case of ANP with late-onset septic shock due to Streptococcus agalactiae. 2. Case Report A 3-week-old girl was admitted to hospital because of irritability and reduced feeding. She was full term, and her birth was a spontaneous vaginal delivery. There was no risk factor for neonatal sepsis (no maternal colonization by Streptococcus group B, no prolonged rupture of membranes). On admission, her weight was 3485？g and she had a high grade fever at 39°C, mottling, and tachycardia at 180 per minute. On examination, a warm and erythematous swelling was noted over the left parotid region. The rest of the physical examination was unremarkable and her fontanelle was normal. Laboratory findings revealed a white blood cell count of 8.5 × 109/L (normal ranges 5–15) with 53% neutrophils, a hemoglobin of 9.5？g/dL (normal 11–16), an elevated plasma procalcitonin of 20？ng/L (normal 0–0,05), an elevated plasma C-reactive protein of 7,5？mg/dL (normal 0–0,3), a hyperlactatemia of 5,6？mmol/L (normal 1–2,8), and a hyperglycemia of 150？mg/dL (normal 60–100). The coagulation, liver, and renal function tests were normal. The blood culture revealed a type III Group B Streptococcus (GBS) or Streptococcus agalactiae. No other organisms were identified from other parts of the body or secretions (urine and cerebrospinal fluid cultures were sterile). Ultrasound revealed enlarged left parotid gland with hypoechoic areas compatible with ANP. No evidence of abscess collection was detected. Also, intraparotid lymph nodes of millimeters in diameter were detected