Sudden-Onset Right-Cheek Swelling in a 69-Year-Old Woman

Liza Cholin, BS; Jordan Burlen, BS; Umar Darr, MD


April 27, 2016

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A 69-year-old woman, recently discharged from the hospital for sepsis secondary to urinary tract infection (UTI), was admitted for acute kidney injury found during laboratory studies performed at a nursing facility. Acute chronic kidney injury secondary to dehydration was diagnosed, and the patient was admitted for rehydration. A sample for urinalysis was collected, and ceftriaxone was started for probable recurrent UTI. The patient's long-term suppressive therapy with doxycycline for left-knee osteomyelitis was also continued.

On the third day of admission, the patient experienced sudden right-cheek swelling, tenderness, and mild difficulty in swallowing. She denied fever, chills, or odynophagia; recent travel or sick contacts; and mandibular pain, changes in hearing, or loss of sensation of the overlying skin of the face.

The patient's medical history includes stage 3 chronic kidney disease, congestive heart failure, coronary artery disease status post-stent, chronic obstructive pulmonary disease, lower-extremity lymphedema, chronic osteomyelitis of the left knee, recurrent UTIs, and a history of extended-spectrum beta-lactamase–positive UTI. Surgical history includes left knee arthroplasty and gastric bypass. The patient has a 60–pack-year smoking history but is currently not smoking. She denied alcohol or illicit drug use.


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