Multiple odontogenic abscesses. Thoracic and abdomino-perineal extension in an immuno competent patient

Odontogenic infection (OI) may lead to death if it extends beyond the buccal area. The virulence of pathogens and the local and systemic status of the patient influence the propagation of the pathogen, either by anatomical continuity or haemematogenous dissemination. Several severe complications derived from OI have been reported in the head, neck and chest. However, OI with an abdominal component, caused by bacteraemia with dental foci or the direct passage of pus from the thorax to the abdomen, are unusual.

We present the case of a young immunocompetent woman who, after false cure of an odontogenic abscess, again reported gynaecological symptoms. A network of connected abdomino-perineal, thoracic and cervical abscesses was discovered.

The peculiarity and severity of this case is a reminder that treatment of an abscessed OI should include intravenous broad-spectrum antibiotics, together with surgical drainage of the purulent collections. Samples should be taken for culture and an antibiogram in order to use specific antibiotics if the initial empirical therapy shows resistance. The diagnosis and follow-up should be by CT, which in our patient showed anatomical continuity of the abscesses from the dental focus. The time sequence of the symptoms, in the absence of any other infectious cause, revealed the descending odontogenic nature of the process.