An 18-year old female, who attends a state university about 90 miles away from home, is brought to her family physician’s office after her parents brought her home because of a mumps epidemic at the university. During the office visit, the patient complained of fever, malaise, myalgia, and anorexia. She also had an ear ache and, due to the swelling of her jaw, reported that it was difficult to chew and swallow. A physical examination found the classic findings of mumps. Both sides of the woman’s face were swollen consistent with bilateral infectious parotitis. Given her recent exposure to other students diagnosed with mumps, the family physician concluded that the patient had mumps and diagnosed her with bilateral infectious parotitis, but could not find evidence of any complications in other body systems. The patient was sent home and was advised to avoid contact with people outside her family. The treatment included analgesics and warm compresses to the parotid area to relieve swelling and reduce symptoms. No medications are known to be effective in treating this viral infection.

The patient is seen in the office of an infectious disease specialist who treated her 1-year previously when she had Lyme disease. She complains of generalized joint pain and stiffness. Based on laboratory test results and physical examination, the physician concludes that the patient no longer has active Lyme disease. However, he concludes that her arthritis of multiple joints is the residual effect, or sequelae, of the cured Lyme disease.