2020 Volume 94 Issue 1 Pages 114-118
A 62-year-old immunocompetent male presented with a 20-day history of fever and a 2-day history of right facial swelling and trismus. The patient was diagnosed as having a buccal abscess suspected of odontogenic infection (OI) and treated with ceftriaxone and clindamycin. However, the patientʼs condition rapidly deteriorated with septic shock, acute respiratory distress syndrome, and disseminated intravascular coagulation due to severe OI. Antibiotics were switched to meropenem, and large amounts of fluids, noradrenaline,and hydrocortisone were intravenously administered. Although Eikenella corrodens and Slackia exigura were detected in both blood and abscess cultures, the patient was not diagnosed as having infective endocarditis. Facial swelling became worse again on day 10 and the wound was drained. The patient was discharged on day 41. Poor oral-hygiene and delay in patient consultation may be risk factors for severe OI. Clinical decision making would benefit by knowing that OI can cause severe, complicated infection in immunocompetent patients and that early recognition of severe disease signs such as trismus can lead to favorable outcomes.
