Endocrine Abstracts

Introduction: Odontogenic facial cellulitis (OFC) is a soft cellulo fatty tissue infection of lesser resistance in different spaces, delimited by the musculoaponeurotic insertions on the maxillary and mandibular bone cortices. when patients have underlying diseases such as diabetes mellitus (DM) or cancer, compromised immune systems may lead to the opportunistic progression of seemingly minor infections. We report the case of a patient who presented an inaugural diabetic ketoacidosis (DKA) revealed by OFC.

Case Report: A 40- year-old female patient with a passive smoking history, presented to the emergency department for consciousness disorders, interview with the family reveals the notion of a toothache 2 weeks before complicated by jugal pain and fever. The physical assessment had revealed a tchycardia of 122 bpm, 100/63 mmhg blood pressure, high respiratory rate 29 cpm and 39.2 °C of temperature. The face was swollen and erythematous with trismus. A facial CTscan was performed which showed collection of the left masseter muscle, hypodense, peripherally enhanced with air bubbles measuring 16^×35.5^×33.5 mm with thickening of the left jugal subcutaneous soft tissue. In the side the biological assessment was in favor of an elevated plasma glucose level of 4.2 g/l, metabolic acidosis and urine ketones. C-reactive protein level was at 291 mg/l with white blood cell count 25910 per mm³. The diagnosis of OFC with an inaugural diabetic ketoacidosis was retained. After stabilization, the management consisted of surgical drainage of the abscess with antibiotic therapy guided by the result of the antibiogram of the pus sample, in addition to insulin therapy and rehydration.

Discussion and Conclusion: OFC is a rare but serious infection which can engage the vital prognosis by its encephalic complication like the thrombophlebitis of the cavernous sinus and cervical like the collections or even mediastinitis especially when it occurs in an immunocompromised state such as diabetes. The diagnosis must be suspected in front of any inflammatory facial pain or swelling on a precarious dental ground. The corner-stone of treatment is based on broad-spectrum antibiotics with surgical draining in suppurative phase in parallel with the management of diabetic decompensation.

Keywords: inaugural DKA-facial-odontogenic cellulitis.