A Lower Lip Infection (Furuncle) Complicated by Abscess of the Lip, Suppurative Cheilitis Glandularis, Lip Necrosis, Septic Bilateral Multilobar Necrotizing (Destructive) Pneumonia, and Pleurisy (Pleuritis): A Case Report and Literature Review

Abstract

Infection of the lower lip can manifest differently. The likelihood of such prompt life-threatening septic complications, as thrombophlebitis, pneumonia, pleurisy, etc, may be underestimated due to the small size of the local inflammation of the lip. We present a 21-year-old Caucasian female with a Staphylococcus epidermidis infection of the lower lip (furuncle) complicated by lip abscess, suppurative cheilitis glandularis, lip necrosis, septic bilateral multilobar necrotizing (destructive) pneumonia, pleurisy (pleuritis), and pulmonary insufficiency of the first degree (type I). Clinical photos of the report demonstrate all stages of the course of inflammation and treatment of the severe lower lip infection from the moment of admission. Preoperative condition, the period of formation and demarcation of necrosis, cleaning of the wound from purulent content, demonstration of fibrinous exudate (also known as fibrinous plaques), the appearance of granulations, and visualization of lip scars as of the day of discharge from the hospital (day 26) are presented. The article also includes a chest X-ray at the time of admission, on the second day, and on the seventh day of hospital stay. The report is enriched as well by three-dimensional multi-slice computed tomography (3D MSCT) images on the eighth, eighteenth, and fortieth days from the moment of admission to our hospital. 3D MSCT of the lungs is showing the areas of pulmonary tissue necrosis and the healing phase. The article contains two videos (cine images) with a duration of 21 seconds and 2 minutes 11 seconds, which demonstrate chest MSCT on the hospital day 8 and 18. The patient was discharged on the 27th day of admission. According to our English-language literature search, it's a first ever reported case of the lower lip furuncle which led such a unique combination of severe local and septic complications documented at all stages of treatment from both aspects clinical and radiological. An update of the classification of uncomplicated and complicated forms of development of furuncles (i.e., boils) and carbuncles is done and presented. More than 37 literary sources were analyzed, and their key aspects complemented our report. Articles with necrotizing fasciitis of the lips were also analyzed.