Acute Parotitis Revealing Recurrent Parotid Sialolithiasis in a Treated Gout Patient: Argument for a Causal Link via the Salivary Urate Nidus Hypothesis

Introduction Recurrent parotid sialolithiasis in a normouricemic gout patient under allopurinol is exceptional. We report a case in which an infectious episode revealed a third recurrence within 18 months, and we propose a causal mechanism linking gout and salivary lithiasis. Case report A 39 year old man with tophaceous gout treated with allopurinol 300 mg/d, serum uric acid 310-340 μmol/L, presented with acute left parotitis, fever 39°C, and purulent discharge from Stensen’s duct. CT showed a 3 mm stone in the left Stensen’s duct. Management included antibiotics, hydration, and sialendoscopy with stone extraction and temporary stenting. Discussion Application of Bradford Hill criteria, evidence of persistent salivary urate hypersecretion despite treatment, and exclusion of other causes of recurrence support a causal role of gout through formation of a salivary urate nidus. Conclusion Control of plasma uric acid alone does not prevent parotid sialolithiasis in gout patients. Salivary urate may represent a new therapeutic target.