Uda Chihiro, Ohta Ryuichi, Koike Takashi, Sano Chiaki
Family Medicine, Fuchu Hospital, Osaka, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2024 Sep 19;16(9):e69742. doi: 10.7759/cureus.69742. eCollection 2024 Sep.
This case report discusses a 69-year-old immunocompromised woman who presented with dyspnea and lower back pain, later diagnosed with an external dental fistula following the observation of a mass and pus discharge on her right cheek. The patient's medical history included idiopathic thrombocytopenic purpura (ITP) and long-term use of immunosuppressive medications, complicating her condition. The fistula was linked to chronic inflammation that had progressed to maxillary bone destruction, requiring both antibiotic therapy and oral surgical intervention. Despite the initial challenge of diagnosing this rare and atypical presentation in elderly, immunosuppressed patients, comprehensive treatment improved her inflammatory markers and overall condition. This case highlights the importance of early detection and multidisciplinary management in preventing severe complications in patients with complex medical histories. It also emphasizes the need for heightened awareness of dental infections in patients with systemic conditions, mainly when presenting atypical symptoms.
本病例报告讨论了一名69岁的免疫功能低下女性，她出现呼吸困难和下背部疼痛，随后在右侧脸颊观察到肿块和脓液排出后被诊断为外部牙瘘。患者的病史包括特发性血小板减少性紫癜（ITP）和长期使用免疫抑制药物，使她的病情复杂化。瘘管与慢性炎症有关，该炎症已发展为上颌骨破坏，需要抗生素治疗和口腔外科干预。尽管在老年免疫抑制患者中诊断这种罕见的非典型表现最初具有挑战性，但综合治疗改善了她的炎症指标和整体状况。本病例强调了早期检测和多学科管理在预防有复杂病史患者发生严重并发症方面的重要性。它还强调了对于患有全身性疾病的患者，尤其是出现非典型症状时，提高对牙科感染认识的必要性。
