选择性IgA缺乏症与青少年慢性复发性腮腺炎

青少年慢性复发性腮腺炎的病因目前并不是十分清楚，一般认为可能和先天性的唾液腺导管发育异常有关系，而一些免疫因素也可能和该病有关联，如选择性IgA缺乏症。

病例基本情况

通过GPT-4总结了两篇病例报道的文献：
第一个¹是一例9岁男孩: The document discusses a case of recurrent parotitis in children associated with selective IgA deficiency, focusing on a 9-year-old boy exhibiting symptoms like fever and swollen parotid gland. The article details the boy’s medical history, including past episodes treated with antibiotics, and outlines his immunological profile, which revealed significantly low levels of IgA. The study emphasizes that while recurrent parotitis is uncommon, its association with immunodeficiency is notable. The document concludes that IgA and other immunoglobulins should be tested in similar cases due to the potential underlying immunodeficiency contributing to the recurrence of the condition.

第二例²是一位6岁男孩：This document presents a case study of a six-year-old boy with selective IgA deficiency who experienced multiple episodes of recurrent parotitis without autoimmune disorder. It reviews the clinical presentation of the boy, including symptoms, physical examination findings, and the results of immunological tests showing low IgA levels. The document highlights the typical characteristics and management approaches for recurrent parotitis, emphasizing conservative treatments like analgesics and massage. It also discusses the broader implications of IgA deficiency and its potential role in the pathophysiology of recurrent parotitis. The report concludes with recommendations for immunoglobulin testing in pediatric patients presenting with recurrent parotitis when no etiology is apparent.

IgA缺乏或其他免疫缺陷性疾病与复发性腮腺炎的关系讨论

两篇文章对IgA缺乏或其他免疫缺陷性疾病与复发性腮腺炎的关系的讨论：

1. IgA Deficiency and Recurrent Mumps:
   Neither of the two articles directly discusses how IgA deficiency causes recurrent mumps. Instead, they focus on the relationship between selective IgA deficiency and recurrent parotitis. IgA deficiency is noted as a condition that might contribute to the susceptibility of recurrent infections due to its role in mucosal immunity, which could include salivary glands affected in recurrent parotitis, but there is no specific mention of recurrent mumps as a direct consequence.
2. Relationship Between Immunodeficiency and Recurrent Parotitis:
   Both articles highlight the significant relationship between immunodeficiency, specifically selective IgA deficiency, and recurrent parotitis. They note that children with this deficiency experience repeated episodes of parotitis, suggesting that IgA’s role in protecting mucosal surfaces might be crucial in preventing these recurrent infections. The articles emphasize that while recurrent parotitis can resolve spontaneously, its association with underlying immunodeficiency like IgA deficiency or other immunoglobulin deficiencies suggests a deeper immunological dysfunction that contributes to the persistence and recurrence of the condition. Thus, testing for immunoglobulin levels is recommended for patients presenting with idiopathic recurrent parotitis to identify potential immunodeficiencies.

治疗

The treatment of recurrent parotitis, especially when associated with selective IgA deficiency, focuses on managing symptoms and preventing complications, as there is no direct cure for the underlying IgA deficiency. Here are some general treatment approaches based on the information from the provided documents:

1. Symptomatic Treatment:

   • Analgesics and Antipyretics: For pain relief and to manage fever, medications like paracetamol can be used.
   • Warm Compresses and Massage: These are recommended to alleviate discomfort and potentially assist in the drainage of the parotid gland.

2. Management of Infections:

   • Antibiotics: Although the efficacy is debatable, antibiotics may be used if a bacterial infection is suspected or confirmed.
   • Sialogogues: Substances that stimulate the flow of saliva, such as lemon candy or juice, may help keep the saliva flowing and reduce stasis, which can lead to infection.

3. Long-Term Management:

   • Regular Monitoring: Regular follow-ups with healthcare providers are crucial to monitor the condition and adjust treatment plans as necessary.
   • Immunoglobulin Monitoring: Since IgA deficiency can be associated with other immunoglobulin abnormalities, periodic monitoring of immunoglobulin levels is advised.

4. Preventative Measures:

   • Hydration: Ensuring adequate fluid intake helps maintain saliva flow and may prevent gland blockages.
   • Dental Hygiene: Good oral hygiene is crucial to reduce the risk of infections that could exacerbate parotitis.

5. Referral to Specialists:

   • Immunologist Consultation: For management of IgA deficiency and any related immune system issues.
   • ENT or Pediatric Surgeon: For severe cases, consultation with specialists might be necessary, especially if there are anatomical issues contributing to the recurrent infections.

It’s important to note that treatment should be tailored to the individual’s specific symptoms and overall health status. Managing the underlying IgA deficiency itself can be challenging since there is currently no way to compensate for the lack of IgA production. Instead, treatment focuses on managing the symptoms and preventing complications of associated infections.

备注：自身免疫性疾病如儿童舍格伦综合症与复发性腮腺炎的关系也已经确立，但是较罕见，且儿童舍格伦综合症的诊断与成人有差异。

1. Shkalim, V., Monselise, Y., Mosseri, R., Finkelstein, Y. and Garty, B.Z. (2004), Recurrent parotitis in selective IgA deficiency. Pediatric Allergy and Immunology, 15: 281-283. https://doi.org/10.1111/j.1399-3038.2004.00163.x ↩

2. Akar HH, Patıroglu T, Duman L. A selective IgA deficiency in a boy who presented recurrent parotitis. Eur J Microbiol Immunol (Bp). 2014 Jun;4(2):144-6. doi: 10.1556/EuJMI.4.2014.2.8. Epub 2014 May 21. PMID: 24883201; PMCID: PMC4029294. ↩