Delayed Diagnosis of Perimandibular Abscess in a Woman With Social Isolation: A Case Report

Social isolation is associated with increased mortality and adverse health outcomes, though its relationship with healthcare utilization remains complex. We present a case of a socially isolated woman in her 70s whose delayed medical consultation contributed to the progression of an initially treatable mandibular infection to a fatal perimandibular abscess. Approximately three months before admission, she began experiencing dental pain but did not seek treatment, in the context of poor oral hygiene and social isolation. A community welfare volunteer eventually found her in a markedly deteriorated state, but she refused transport for one week before agreeing to seek care. She presented in septic shock with altered mental status and left facial swelling. Laboratory studies revealed severe systemic inflammation, and imaging identified an extensive left perimandibular abscess. Blood cultures grew Parvimonas micra, an anaerobic oral commensal. Despite antimicrobial therapy and drainage, infection control was not achieved due to the extent of the abscess, and she died on hospital day 32. This case illustrates how poor oral hygiene and social isolation can together contribute to delayed diagnosis and fatal infectious complications, underscoring the need for proactive symptom screening among socially vulnerable older adults.