Primary Diffuse Large B-Cell Lymphoma Mimicking a Dental Abscess: A Case Report

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, yet its presentation in the maxillofacial region can pose diagnostic challenges, particularly in patients with confounding medical histories. We report the case of a 40-year-old Iranian male with a history of ulcerative colitis on mesalazine therapy, who presented with progressive left facial swelling. Symptoms persisted for over a year, during which initial fine-needle aspiration (FNA) of a cervical lymph node showed only chronic lymphadenitis. This result prompted repeated empiric treatments with antibiotics and anti-inflammatory medications, without lasting improvement and leading to significant diagnostic delay. Upon referral to the Department of Oral and Maxillofacial Medicine at Tabriz Faculty of Dentistry, the presentation initially mimicked an odontogenic abscess or other dental pathology, a common consideration in cases of unilateral facial swelling evaluated in a dental setting. However, a panoramic radiography revealed no dental or periodontal source of infection, effectively ruling out an odontogenic origin and prompting further investigation. Clinical examination disclosed firm, fixed, nontender lymphadenopathy involving the left submandibular and cervical nodes. Subsequent referral to a hematologist and excisional lymph node biopsy with immunohistochemistry confirmed DLBCL. Treatment was promptly initiated, and a CT scan performed 10 months later demonstrated complete response to therapy. This case underscores the critical importance of maintaining a high index of suspicion for lymphoproliferative disorders, such as DLBCL, in patients with persistent cervicofacial swelling and inconclusive initial investigations (including misleading FNA results). It also highlights how such malignancies can closely mimic odontogenic infections in the dental setting, where early panoramic radiography and precise examination of teeth and periodontium can help exclude dental sources and accelerate referral for non-odontogenic causes. Early consideration of excisional biopsy in refractory cases can prevent prolonged diagnostic delays and enable timely intervention.