# Unusual Presentation of Odontogenic Cellulitis Mimicking Drug-Induced Angioedema: A Case Report

## TL;DR

A case report describes a dental infection mistaken for an allergic reaction, highlighting the importance of dental evaluation in facial swelling diagnosis.

## Contribution

The case highlights the diagnostic challenge of distinguishing odontogenic cellulitis from drug-induced angioedema.

## Key findings

- A patient's facial swelling was initially misdiagnosed as drug-induced angioedema but was later found to be odontogenic cellulitis.
- Treatment with antibiotics, surgical drainage, and tooth extraction led to full recovery.
- Comprehensive dental evaluation is crucial to avoid misdiagnosis and inappropriate treatment.

## Abstract

Facial cellulitis secondary to odontogenic infections can present with clinical features that closely mimic drug-induced angioedema, leading to diagnostic confusion and delayed appropriate treatment. We report a 23-year-old female who presented with rapid-onset bilateral midfacial swelling following her first exposure to ibuprofen. Initial clinical assessment by a general practitioner suggested drug-induced angioedema, and the patient was treated with antihistamines and corticosteroids. However, a detailed dental examination revealed a non-vital maxillary lateral incisor with associated periapical pathology. Clinical features, including erythema, warmth, and tenderness, along with laboratory findings demonstrating neutrophilia without eosinophilia and radiographic evidence of periapical infection, ultimately confirmed the diagnosis of odontogenic cellulitis rather than allergic angioedema. The patient was admitted and treated with empirical broad-spectrum intravenous antibiotics, followed by surgical drainage and extraction of the offending tooth, resulting in complete resolution within seven days. Definitive treatment with cyst enucleation was performed one week post-discharge with satisfactory outcomes. This case emphasizes the critical importance of comprehensive dental evaluation in patients presenting with bilateral facial swelling, even when drug exposure temporally correlates with symptom onset, as proper differential diagnosis prevents inappropriate treatment and ensures optimal patient outcomes.