A 36-year-old male patient with severe continuous pain and swelling of tongue for 6 weeks was presented to Goba Referral Hospital. He is a farmer, married, and has two children. The swelling was 2 cm by 1 cm, located on posterior central tongue, and frank pus oozed from the center of swelling. The patient had associated dysphagia, odynophagia, and speech difficulty but no dyspnea. He had voluntary fixation of tongue because of pain. He had a history of left upper side and last molar tooth extraction before 10 years. Currently, he has been suffering from toothache and dental caries on the adjacent molar. He also had poor dental hygiene. The patient had no history of fever and chills. Additionally, he had no history of tongue bites or tongue trauma in the last 6 months. He had no previous personal and family history of similar illness and tonsillitis. The patient had no submandibular swelling, history of seizure, diabetic mellitus, hypertension, and retroviral infection. He had never eaten fish throughout his life but had consumed barley, milk, and sometimes wheat. The patient had no history of chewing chat, cigarette smoking, and drug use except for taking beer once per 1-2 months.
Before the patient visited our hospital, he was first treated at a health center where he was diagnosed with tonsillitis and was given amoxicillin 500 mg po tid (orally three times a day) for 7 days and paracetamol 1 g po prn. Although he showed mild improvement following treatment, the symptoms worsened after the completion of the course of antibiotics. Then, for the second time, the patient went to a private clinic where he was given augmentin 625 mg po bid for 7 days and tramadol 50 mg po prn. However, the patient was not relieved of pain and swelling.
With a diagnosis of pyogenic lingual abscess with lingual tuberculosis and tongue tumor as differential diagnosis, the patient was investigated. Random serum glucose level was 120 mg/dL, complete blood count was within normal range, and HIV antibody test was negative. Additionally, liver and renal function tests were done and found to be normal. Furthermore, venereal disease research laboratory test, and hepatitis B serum antigen and hepatitis C virus antibody tests were done and the results were negative.
An incision of 1 cm was made and 10 cc of thick frank pus was drained. A sample was taken from the drained pus and Gram staining was done; the report revealed Gram-positive cocci in clusters. However, acid fast bacilli test was negative. After drainage, augmentin 625 mg po tid for 7 days, metronidazole 500 mg po tid for 5 days, and diclofenac 50 mg po bid for 5 days was given, and the patient was relieved of pain after 48 hours of drug administration. The diagnostic difficulty in this patient was due to two reasons: 1) since lingual abscess is a very rare disease, patient was misdiagnosed in the health center as well as in the private clinic and 2) absence of culture and sensitivity service in our hospital. The patient was followed for 6 months and the condition did not relapse.