380 - First Reports of Salivary Gland Involvement in Corona Virus Disease 2019

Background: Many viruses infect salivary glands. These include mumps, Epstein-Barr, herpes virus 6, parainfluenza, influenza, adeno virus, boca virus and others. Almost all coronavirus disease 2019 (COVID -19) infected patients carry the virus in saliva. Salivary duct epithelium were the early target cells in macaque monkeys infected with severe acute respiratory syndrome corona virus (SARS-COV). Here we present 2 COVID-19 cases with the involvement of salivary glands. Salivary gland involvement has not been reported in COVID-19.

Methods: We followed the COVID 19 clinical findings in a Pennsylvania long term care facility with 190 residents. Thirty tested polymerase chain reaction (PCR) positive. However, 48 were presumed infected. Eighteen likely cases were not tested due to shortage of swabs. Thirty four employees also tested positive. Two out of 48 patients aged 78 and 88 developed unilateral sialadenitis during the course of the illness. Both were Hispanic females. We studied the Clinical presentations, co-morbidities, lab and imaging results and the outcome.

Results: Case 1: Two days after the first confirmed case, a 88 year old Hispanic female developed fever and fatigue and tested COVID-19 positive. Fever lasted 5 days. Twenty days later the patient developed a 5x3 cm tender left parotid mass and hypoxia treated with oxygen via nasal cannula. (Table 1)
Case 2: A 78 year old Hispanic female developed high fever and cough 7 days after the index case. Six days later she had persistent fever and presented with a tender 8.5x3.5 cm right submandibular mass. The patient was intubated for 3 days to protect the airway due to the size of the mass. Both made an uneventful recovery. (Table 1 and Figure 1)

Conclusion: New clinical findings of COVID -19 have been gradually added during the course of the pandemic. The virus is almost universally present in the saliva. In experimental Chinese macaques with SARS-COV early target cells were the salivary duct epithelium. Salivary gland inflammation and swelling should be included amongst the clinical features of COVID-19.