Osteomyelitis of anterior maxilla involving bilateral sinuses post-rodenticide toxicity: a case report

BACKGROUND: Osteomyelitis is an uncommon but serious infection of the maxilla, often associated with dental infections, maxillary sinusitis, or systemic conditions that compromise immunity. Maxillary involvement is rare compared to mandibular osteomyelitis. While recognized predisposing factors include diabetes mellitus, autoimmune disorders, and anemia, rodenticide exposure has not previously been reported as a cause. To our knowledge, this is the first documented case of maxillary osteonecrosis secondary to rodenticide toxicity. CASE PRESENTATION: A 27-year-old Indian woman presented with pain, palatal swelling, purulent nasal discharge, and mobility of anterior maxillary teeth. Her medical history revealed intentional ingestion of rodenticide (cholecalciferol, warfarin, bromethalin) requiring 10-day hospitalization. Approximately 3 weeks after discharge, she developed a palatal ulcer that progressed to necrosis. Clinical evaluation, CT imaging, and endoscopic findings confirmed anterior maxillary osteomyelitis with bilateral sinus involvement. Surgical debridement and extraction of involved teeth were performed. Histopathology demonstrated necrotic bone with chronic inflammatory infiltration. Fungal studies were negative. Postoperative healing was uneventful, and no recurrence was observed. CONCLUSIONS: This case illustrates a rare but plausible toxicologically mediated osteonecrosis of the maxilla, likely secondary to rodenticide-associated coagulopathy and subsequent mucosal ulceration, leading to secondary bacterial invasion. Early recognition of unusual etiological factors, meticulous history-taking, and timely surgical intervention are essential for preventing progression and deformity.