Acute Submandibular Sialadenitis in Children During the 2025–2026 Influenza Season: A Retrospective Case Series from a Digital Consultation Network

Background: Acute submandibular sialadenitis in children can raise concern for bacterial infection or obstruction. Viral-associated salivary gland inflammation is described, particularly involving the parotid gland; however, the clinical features of pediatric submandibular presentations are less well characterized. Methods: We conducted a retrospective descriptive case series of children with acute tender submandibular swelling and concurrent or recent respiratory or influenza-like symptoms whose cases were discussed through a secure physician-to-physician digital consultation network in northern Israel between November 2025 and February 2026. Clinical, laboratory, imaging, management, and outcome data were extracted from consultation discussions and available medical documentation. Results: Fifteen children were included (median age, 8 years; interquartile range, 5.75–13.5; 12/15 male). All children had viral infection symptoms; twelve children (80%) had preceding respiratory symptoms, and 10 of these 12 had fever during the preceding week. Influenza A PCR was performed in five children and was positive in all five. The remaining ten children were not tested for influenza, and their presentations were considered clinically suggestive of a viral illness. All children had tender submandibular gland enlargement without documented clinical signs of suppuration. Ultrasound was performed in seven and showed glandular enlargement without ductal dilatation, abscess, or fluid collection. All received supportive care; three (20%) also received antibiotics. No emergency department referrals or hospital admissions were documented, and clinical resolution without reported sequelae was recorded in all 15 children. Conclusions: This case series describes a cluster of acute, non-suppurative submandibular sialadenitis identified through a clinician-to-clinician consultation network during an influenza season. Although influenza A was confirmed in only five patients, the temporal clustering and clinical presentation suggest a possible association with circulating respiratory viruses. The physician-to-physician digital consultation network facilitated the recognition and discussion of this cluster of atypical submandibular sialadenitis cases. Documented consultations in which antibiotic treatment was considered but subsequently withheld suggest that timely specialist input may support clinical decision-making and antimicrobial stewardship in primary care. Further studies are needed to evaluate the impact of such networks on clinical management and healthcare utilization.