Maxillary Osteomyelitis with an Incidental Diagnosis of Maxillary Diffuse Large B-Cell Lymphoma: A Case Report

Abstract

Raoultella planticola osteomyelitis is rarely reported in the literature. The most likely source in our case is the oral microbiome secondary to the tooth extraction. Herein we present a case of Raoultella planticola osteomyelitis of the jaw that leads to the diagnosis of diffuse large B-cell lymphoma (DLBCL) of the jaw. A 75-year-old male with no significant medical history, presented to the emergency department with right upper jaw pain after he had a tooth extraction a week before his presentation. Computed tomography (CT) scan of the face showed concerns of right maxillary osteomyelitis with soft tissue swelling and prominent cervical lymph nodes. He underwent a bone biopsy of the maxilla and was started on intravenous ampicillin-sulbactam. His bone culture grew pan-sensitive Raoultella planticola. in addition to that, his bone biopsy revealed diffuse large B-cell lymphoma of the jaw. The patient underwent staging imaging, and he was found to have metastasis to the liver. He was started on chemotherapy and had a good response. In conclusion, Raoultella planticola osteomyelitis is extremely rare. The diagnosis of maxillary DLBCL can be a challenge. Fortunately, our patient had an infection at the same site that led to the diagnosis of DLBCL.

Diffuse large B-cell lymphoma in and of the bone. Forms and potential precursors

“…▪ Chronic recurrent multifocal osteomyelitis (CRMO): There are different case reports on patients diagnosed with bone DLBCL after years of CRMO, especially in younger patients. ▪ Moreover, infectious osteomyelitis in general has been seen associated with other types of tumor, e.g., carcinoma and sarcoma and even DLBCL [19,20] Asif et al in 2019 describe the case of a 75 years old patients, diagnosed with osteomyelitis caused by Raoultella planticola infection and subsequent discovery of DLBC [21]. Senthilvel et al in 2011 report on a 51 years old patient, with a rare primary DLBCL of the skull that was distinguished from osteomyelitis only by biopsy of the tumor mass.…”