Nontuberculous mycobacterial parotitis in an elderly woman with Sjögren’s syndrome and diabetes mellitus: a case report

Abstract

Nontuberculous mycobacterial infection of the parotid gland is rare in adults and poses a diagnostic dilemma due to its non-specific presentation and resemblance to bacterial parotitis or neoplastic condition. Coexisting autoimmune salivary gland disease may further obscure diagnosis. We report a case of an elderly woman who presented with a progressive, painful left parotid swelling refractory to multiple courses of antibiotics. Imaging revealed multiple intraparotid micro-abscesses and fatty degeneration of other salivary glands, prompting evaluation for an autoimmune disorder. Sjögren’s syndrome was confirmed serologically, and diabetes mellitus was newly diagnosed. Fine-needle aspiration demonstrated acid-fast bacilli, with cultures confirming Mycobacterium abscessus. The patient was successfully treated with prolonged, targeted combination antimicrobial therapy, resulting in clinical resolution. NTM infection should be considered in refractory parotid infections, particularly in the presence of underlying autoimmune or metabolic comorbidities. Early microbiological diagnosis enables appropriate therapy and may prevent unnecessary surgical intervention.