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

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

Disclosures

April 27, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

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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