Cervicofacial cellulitis in HIV-positive patients: Two case reports.

BACKGROUND: Cervicofacial cellulitis (CCF) is a severe deep neck infection involving the cervical fascial spaces, most commonly of odontogenic origin. It may rapidly extend to adjacent compartments and lead to life-threatening complications such as mediastinitis, necrotizing fasciitis, and septic shock. In immunocompromised patients, particularly those infected with human immunodeficiency virus (HIV), the clinical course may be more aggressive due to impaired cellular immunity. AIM: This study aims to report two cases of severe cervicofacial cellulitis revealing previously undiagnosed HIV infection and to emphasize the importance of early diagnosis and multidisciplinary management. CASES: We describe two patients who presented with extensive cervicofacial cellulitis complicated by mediastinal extension and systemic involvement. Both required urgent contrast-enhanced computed tomography, broad-spectrum intravenous antibiotics, and extensive surgical drainage. In the first case, the infection progressed to septic shock and necrotizing fasciitis. The causal tooth was extracted during surgery. Microbiological cultures isolated Klebsiella pneumoniae and α-hemolytic Streptococcus. In both cases, HIV infection was diagnosed during hospitalization. CONCLUSION: Cervicofacial cellulitis may represent the first clinical manifestation of undiagnosed HIV infection. Severe or atypical deep neck infections should prompt systematic HIV screening. Early imaging, targeted antimicrobial therapy guided by microbiological findings, and coordinated surgical and medical intervention are essential to improve patient outcomes.