Coagulopathy-induced lingual abscess

Introduction:

Lingual abscesses are extremely rare in the antibiotic era and because of the physiological and immunological characteristics of the tongue. Essential thrombocythemia is a chronic myeloproliferative disorder characterized by thrombocytosis, megakaryocytic hyperplasia and thrombohemorrhagic complications. Acenocoumarol is used as an anticoagulant. Hydroxyurea is a drug used to treat myeloproliferative diseases.

Methods:

Our team present a clinical case of a tongue abscess in a 80-years-old lady with essential thrombocythemia and FA on a anticoagulant and cytotoxic therapy. The patients presents in the ER with pain in the oral cavity and odynophagia. She mentioned about a swelling in the oral cavity and dentures not fitting properly. On examination dysphagia and dysarthria were encountered. The oral tongue was immobile and there was a blood-stained discharge with an unknown source. On MRI study there was an increased T2 signal intensity on the left side of the tongue and its root.

Results:

Her present coagulation status was severely impaired and it was a contraindication both for a puncture and aspiration and a surgical incision. An intravenous therapy with antibiotics and corticosteroids was initiated. In a few days a purulent discharge appeared from a spontaneously formed fistula of the tongues' abscess. The overall condition of the patient got better.

Conclusion:

We speculate that this complicated case had the following sequence: 1. Spontaneous hemorrhage in the tongue.2. Subsequent abscess formation. 3. Spontaneous fistula formation with drainage which led to a self-healing of the process.

Conclusion:

We assume that the coagulation status of the patient was a contraindication for the diagnosis as well as the surgical treatment of the process.

Publication History

Publication Date:
23 April 2019 (online)