Lingual abscess in a heavy smoker

Abstract

Lingual abscess is an extremely rare disease that misdiagnose may lead to sepsis and/or airway obstruction. A 50-year-old male patient was admitted to our emergency service with complaints of swelling of his tongue, pain and dysphagia. The swelling and pain had started 4 days ago and had been increasing gradually. Additionally, over the last 24 hours, dysphagia and difficulty in speaking developed. He was a heavy smoker (2 packets/day for 35 years). His medical history revealed neither a predisposing factor such as a chronic disorder including immunosuppression nor recent history of oral trauma. His physical examination revealed poor oral hygiene and a red, swollen tongue. There were two painful, protuberant lesions with purulent discharge: one located over the tongue and the other located sublingually. He had hoarse voice and saliva was discharging from his mouth. He had fever, leukocytosis and elevated C-reactive protein. Fine needle aspiration was performed and broad spectrum antibiotics were given. The culture result revealed gram-positive cocci and anaerobes. The patient was discharged at his 8 th day of admission, following regression of his symptoms. In conclusion, this case leads us to suggest that smoking may be an etiological factor in the development of lingual abscess in patients with no other identifiable etiological factors. Although clinical explanations related to lingual abscess are not generally mentioned in the majority of classical essential textbooks, emergency service physicians and head-neck surgeons should be aware of this situation which may lead to fatal consequences.