Progressive Facial Swelling and Airway Symptoms Revealing a Deep Neck Abscess With Atypical Microbiology

Deep neck abscesses have become less common in the antibiotic era; yet, they still pose major risks of morbidity and mortality if not addressed appropriately. Their proximity to the upper respiratory tract and mediastinal structures further exacerbates this risk. We present the case of a 56-year-old man with a medical history of type 2 diabetes mellitus, who exhibited a two-month history of recurrent left-sided facial edema, pain, and dysphagia. Computed tomography imaging confirmed a substantial fluid collection extending from the submandibular region into the mid-cervical area, from which aspiration yielded 110 mL of purulent material. Cultures indicated Cutibacterium acnes, an unusual culprit of deep neck space infections. Additional cytological analysis identified atypical squamous cells, further complicating the diagnosis. This case emphasizes the need to evaluate atypical microorganisms in deep neck infections, especially in patients with comorbidities.