Osteomyelitis of maxilla with orbital cellulitis after tooth extraction

Osteomyelitis of the maxilla with orbital cellulitis, an uncommon and life-threatening disease, can be misdiagnosed. We here report a 13-year-old boy, possibly with combined immunodeficiency disease, who presented with osteomyelitis of the maxilla and orbital cellulitis after tooth extraction. Computed tomography demonstrated thickening of the left maxillary bone. Magnetic resonance imaging showed inflammation in the left maxillary bone and retrobulbar space. Metagenomic analysis of an aspiration biopsy resulted in a diagnosis of infection with Porphyromonas endodontalis. He was successfully treated with metronidazole.