Background: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, with a range of extrapulmonary manifestations. Rarely , it presents without respiratory symptoms, and salivary gland enlargement is not well described. We report a rare case of M. pneumoniae infection presenting as prolonged fever and bilateral parotid gland enlargement. Case report: A 2.5-year-old boy presented with a 7-day history of fever. Systemic review was unremarkable, with no respiratory symptoms. Examination revealed bilateral parotid gland enlargement and mild splenomegaly . Initial investigations showed leukocytosis (WBC 20,000/μL, neutrophil predominance), CRP 35 mg/L, and ESR 17 mm/hr. Intravenous cefuroxime was commenced for presumed bacterial infection. As fever persisted, further investigations—including chest radiograph, lumbar puncture, and echocardiography—were within normal limits. Intravenous cefotaxime and clarithromycin were initiated to cover possible M. pneumoniae and other bacterial pathogens. WBC decreased to 15,000/μL, but fever spikes continued. M. pneumoniae antibody titre was >1:160. After 5 days of clarithromycin without resolution, oral levofloxacin was started, resulting in complete defervescence within 24 hours. Discussion: This case underscores the need to consider M. pneumoniae infection in children with prolonged fever, even in the absence of respiratory symptoms or typical extrapulmonary features. It also highlights the emerging issue of macrolideresistant M. pneumoniae, particularly in Asian regions, which may necessitate alternative antimicrobial strategies. Registrar In Paediatrics459