Introduction Osteomyelitis of the jaw is a rare occurrence. Few cases were described in immunocompromised patients. We report an unusual case of mandibular osteomyelitis arising from odontogenic infection in a previously healthy 12-year-old girl. We aim to increase awareness of a severe and underdiagnosed condition. Case report A healthy 12-year-old girl presented to the dentist with a 15-day long toothache associated with left jaw swelling. She received 7-days treatment with metronidazole and amoxicillin for the odontogenic abscess. After that, she underwent drainage of the abscess, and the antibiotics were continued for seven more days. Despite the treatment, the girl had two febrile episodes and persistence of pain, local edema, and weight loss. Thus, she was hospitalized with swelling and hypoesthesia of the left jaw, trismus, dysphagia, and tenderness to palpation. The intra-oral inspection revealed poor oral hygiene and a high amount of dental cavities (Figure 1). Her initial white blood cell count and ultrasonography of the salivary glands were normal; also, the blood culture, immunoglobulins, and HIV were negative. The C-reactive protein was slightly elevated (18 mg/dL). We initiated empiric therapy with amoxicillin-clavulanate. After 48 hours of hospitalization, a neck computed tomography (CT) revealed two abscess collections in the left jaw, cancellous bone destruction, cortical disruption and an inflammatory reaction of the surrounding muscles of mastication, compatible with jaw osteomyelitis (Figure 2). Therefore, the patient underwent another drainage and biopsy examination. Gram stain and cultures were negative. We changed her antibiotic regimen to ceftriaxone and clindamycin. After three weeks of parenteral antibiotic, she was discharged without pain, with trismus and hypoesthesia regression, but the jaw swelling persisted. An oral antibiotic (clindamycin) was prescribed for two more weeks. Discussion The odontogenic abscess is a frequent complication of odontogenic infection. Poor oral hygiene, high ingestion of carbohydrates, puberty, and poverty are some well-known risk factors to this disease. The involvement of alveolar bone may progress to osteomyelitis. This case report is a rare type of osteomyelitis in a healthy adolescent. Children and adolescent with mandibular osteomyelitis usually present risk factors like immunodeficiency, previously irradiation, mandibular fracture, hemoglobin diseases, diabetes mellitus or chemotherapy; conditions that imbalance the immune system or modify the normal anatomy of the jaw. A bone biopsy is the gold standard for the diagnosis of osteomyelitis, and the CT scans may also be used. This patient’s CT scan suggests the rapid progression of the disease and massive bone destruction and her biopsy examination results consistent with osteomyelitis. Conclusion The odontogenic abscess is rarely severe in children and adolescent. Nevertheless, a small number of cases may progress to severe infection and complication of jaw osteomyelitis. Clinicians should be aware of establishing quick diagnosis and treatment to avoid progression to chronic osteomyelitis

Figure 1

A 12-year-old girl with left jaw swelling and dental cavities

Figure 1

A 12-year-old girl with left jaw swelling and dental cavities

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Figure 2

Neck computed tomography showing two abscess collections and osteomyelitis in the left jaw

Figure 2

Neck computed tomography showing two abscess collections and osteomyelitis in the left jaw

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