ID Fellows Cup Question 19

A 56-year-old male with poorly controlled diabetes presents to the clinic for evaluation of a draining facial wound. He rarely follows with physicians but recently did require 3 dental extractions for periapical abscess. His wound lies just anterior to right ear, near where his dental extractions occurred.

He states that approximately 4 weeks after the dental work his wound opened and began to drain. The dental surgeon prescribed 2 weeks of amoxicillin/clavulanate, which resulted in temporary improvement. However, his wound recurred following the discontinuation of antibiotics.

On exam you unroof a sinus tract, with minimal surrounding erythema, draining thin purulent fluid which you gram stained below.

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