Acute Bilateral Parotitis during Chemotherapy for Acute Lymphoblastic Leukemia

John E. Humphries, MD, Department of Pathology, Box 214, University of Virginia Health Sciences Center, Charlottesville, VA 22908 (USA) Shpilberg et al. [1] recently presented a 62-year-old man who developed recurrent bilateral parotitis during chemotherapy for acute myelogenous leukemia. The development of parotitis was attributed to the chemotherapy, which consisted of cytarabine and daunorubicin. We observed a similar phenomenon during the treatment of a young man with acute lymphoblastic leukemia. A 23-year-old male with acute lymphoblastic leukemia was admitted for chemotherapy and placement of an Ommaya reservoir. He received 10 days of L-asparaginase (500 IU/kg/day) with prednisone (100 mg p.o. per day for 7 days). On the 9th hospital day an Ommaya reservoir was placed without incident. Because of the presence of lymphoblasts on the peripheral blood smear, cytarabine (100 mg/m2 by continuous infusion for 7 days) and daunorubicin (45 mg/m2 i.v. for 3 days) were begun on the 11th hospital day. Methotrexate (12 mg) was administered through the reservoir on the 14th hospital day. On the 6th day of cytarabine (hospital day 18) the patient noted the acute onset of pain, tenderness and swelling in the parotid region bilaterally. Apart from bilateral parotid swelling, examination of the head, ears, nose and throat was unremarkable. The results of serum amy-lase determination are shown in figure 1. A serum lipase was normal (5 IU/dl; normal range 4-24 IU/dl), suggesting that the parotid glands rather than the pancreas were the source of the dramatic rise in serum amylase. Cytarabine infusion was completed the next day and within 2 days the swelling and discomfort had spontaneously resolved. Cyclocytidine, a chemotherapeutic agent which must first be converted in vivo to cytarabine to become active, induces parotid pain and sialorrhea [2]. These adverse effects appear to be primarily mediated through action on 1000 L-asparagmase 800 Cytarabine