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Abstract: A young male presented to the hospital with the chief complaint of “fever, parotid enlargement for 6 days, and swelling and pain in the right testicle for 3 days”. He was diagnosed with “mumps with orchitis” and given ribavirin antiviral, sugar supplementation, and testicular support with a d-rest.
Basic information】Male, 36 years old
Type of disease】Mumps (mumps virus infection), orchitis
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】January 2020
Treatment plan】Medication (ribavirin injection, conversion sugar injection) + d-rest to hold up the testicles
Treatment period】Inpatient treatment for 3 days, outpatient follow-up after 1 week
Treatment effect】The patient improved
I. Initial consultation
A young man came to our outpatient clinic with the complaints of “parotid swelling and pain for 6 days and right testicular swelling and pain for 3 days”. Three days ago, he developed painful swelling of the right testicle with high fever and a temperature of 39.5℃, accompanied by chills, chills, nausea and loss of appetite, but no vomiting, abdominal pain or diarrhea. Yesterday, he was examined for blood and urine amylase and the results showed elevated values. We examined the patient and found that the patient had a red throat, small tonsils, enlarged parotid area bilaterally, no redness or swelling at the mouth of parotid ducts, a 1×1 cm sized mass in front of the earlobes bilaterally, and an enlarged right testicle with light tenderness. The blood amylase value: 322 U/L, urinary amylase: 2469 U/L, urinary routine was normal, blood leukocyte value: 9.1×10^9/L, neutrophil percentage: 7.7×10^9/L. The patient was then examined by testicular ultrasound, the results showed that the right testicle and epididymis were enlarged and there were inflammatory changes, the preliminary diagnosis was mumps combined with orchitis, which required inpatient isolation. The patient agreed and was admitted to the ward.
II. Treatment process
After admission, the patient was given respiratory isolation and advised to rest in bed, eat a light diet, and not to eat acidic food. The patient’s liver and kidney function was normal and the patient was positive for hepatitis B surface antigen. The patient’s case was characterized as a young male with fever and bilateral parotid enlargement, testicular enlargement, significantly elevated blood and urine amylase, and normal white blood cells. The patient was given ribavirin injection intravenously for antiviral treatment, and converted sugar injection for electrolyte replenishment, while the testicular area was held up with a d-ring brace.
III. Treatment effect
After active treatment, the patient’s condition quickly improved, the fever stopped, the swelling of bilateral parotid glands was reduced, and the swelling and pain of testicles were reduced. However, since mumps is a contagious disease and the isolation period is 21 days, the patient is still contagious and may infect his family since the disease is less than 2 weeks old. After explaining his condition to the patient and his family, the patient still requested to be discharged, so he was given a transfer to the hospital and told to pay attention to isolation before discharge.
IV. Notes
We are glad that after a series of treatment, the patient’s condition has recovered and all conditions have improved. However, since the patient is still in isolation, he still needs to pay attention to control himself after discharge to prevent transmission to his family. Common precautions include the following.
1. home isolation is required after discharge, with attention to indoor window ventilation, daily disinfection, preferably living alone and away from children to avoid infecting family members who are not immune to mumps, and medical isolation can be lifted after 3 weeks from the onset of the disease.
2. after discharge, patients should take rest, eat a light diet, avoid acidic food stimulation, keep their mouth clean and pay attention to rinsing after eating.
3, the patient should continue antiviral treatment after discharge, can follow the doctor’s prescription oral busulfan anti-inflammatory oral solution, and 1 week after discharge for outpatient follow-up, review blood routine, blood urine, amylase, urinary ultrasound, etc.
4. This patient is a carrier of hepatitis B virus, so he should avoid straining and drinking in daily life, avoid overuse of drugs and other behaviors that aggravate the burden on the liver, and also need to regularly check liver function, hepatitis B virus quantification, liver ultrasound, etc.
V. Personal insight
Mumps is an acute respiratory infection caused by the mumps virus with an isolation period of up to 3 weeks. Patients often present with fever and swollen parotid glands, but in fact, the virus can invade various glands in the body and therefore often combines with a variety of complications, the most common complications in men being orchitis and epididymitis, and in women being ovaritis. The patient in this case had a combination of testicular infections, which is why he had testicular pain. Once mumps develops, the patient is usually uncomfortable and often anxious, and many people will be concerned about this, but currently mumps can be prevented by vaccination, and if the infection has occurred, do not be overly alarmed, but go to the hospital in time for antiviral treatment to achieve a good prognosis.