Multidisciplinary management of severe odontogenic maxillofacial multi-space infection in a patient with HIV-syphilis coinfection and advanced immunosuppression: a case report.

Background: HIV-syphilis coinfection poses a substantial challenge in the management of severe odontogenic infections, with few reports addressing maxillofacial multi-space infections in this setting. Case presentation: A 50-year-old man developed severe left maxillofacial multi-space infection one week after molar extraction, presenting with respiratory distress, trismus, elevated C-reactive protein (235.20 mg/L), computed tomography evidence of gas-forming abscesses, reactive HIV antibody, positive syphilis serology, and a CD4+ T-cell count of 133.76 cells/μL. Emergency tracheostomy and incision and drainage were followed by multidisciplinary management comprising sequential antibacterial therapy, intravenous aqueous penicillin G, early antiretroviral therapy, and trimethoprim-sulfamethoxazole prophylaxis. The patient was decannulated on postoperative day 23 and discharged on day 25; the CD4+ T-cell count rose to 321.53 cells/μL within three weeks. At four-month follow-up, the infection had not recurred, the CD4+ T-cell count reached 415.36 cells/μL, and the RPR had reverted to negative. Conclusion: In patients with advanced immunosuppression, odontogenic multi-space infection mandates prompt airway control, adequate surgical drainage, sequenced pathogen-specific pharmacotherapy, and multidisciplinary collaboration.