Thoracic Extension of an Odontogenic Deep Neck Space Infection: A Case of Carbapenem-Resistant

Background: Deep neck space infections (DNSIs) of odontogenic origin are serious infections that may extend into mediastinal and thoracic compartments, causing life-threatening complications. Empyema secondary to carbapenem-resistant Case Presentation: A 22-year-old previously healthy Arab male presented to the emergency department with fever, left facial swelling, trismus, and dysphagia following untreated dental caries. Examination and imaging revealed a descending infection from deep neck space abscess toward the thoracic cavity. Despite incision and drainage of the buccal abscess, from which Discussion: This case underscores the aggressive nature of odontogenic DNSIs and their potential for thoracic extension even in immunocompetent young adults. It also highlights that highly drug-resistant organisms such as CRAB may occasionally be encountered in severe infections outside classical intensive-care environments, particularly in settings with extensive antibiotic exposure and limited access to newer agents. Early diagnosis, multidisciplinary management, and culture-guided therapy were key to a favorable outcome. Conclusion: Odontogenic DNSIs complicated by empyema represent a rare but severe condition. The unusual involvement of CRAB in this context emphasizes both the clinical severity and the therapeutic limitations associated with multidrug-resistant pathogens and underlines the need for timely drainage and appropriate, susceptibility-guided antibiotic therapy.