First manifestation of acute exacerbation of idiopathic interstitial pneumonia during emergency maxillary drainage: a case report.

Acute exacerbation of idiopathic interstitial pneumonia (AE-IIP) can be triggered by invasive procedures and carries a mortality rate of approximately 50%. We report a case of a 73-year-old man who presented to a dental emergency room with maxillary swelling and a fever of 39.0℃. Initially, the patient was prescribed analgesics and antibiotics. The following day, because of an elevated C-reactive protein (CRP) level (18.0 mg/dL), emergency incision and drainage were performed. During the procedure, he developed tachypnea, dry cough, and hypoxia (SpO2, 85-90%). The patient was immediately transferred to a medical emergency hospital, where chest computed tomography confirmed the diagnosis of IIP. The patient was admitted to the respiratory care unit and was treated with corticosteroid pulse therapy and antibiotics. The patient was discharged on day 39 with ambulatory oxygen therapy. High CRP levels and acute hypoxia may be critical early indicators of AE-IIP. Dental anesthesiologists must recognize that oral infections can trigger severe and potentially fatal systemic inflammatory responses, including AE-IIP.