Unusual complication of intralesional corticosteroid in oral submucous fibrosis patient

Formation of bilateral buccal sterile abscess following intralesional corticosteroid injection for the management of oral submucous fibrosis (OSMF) has not been reported in the literature. The main aim of this case report is to highlight the unusual complication of intralesional steroid in the form of abscess formation in a patient with oral submucous fibrosis. Patient was a diagnosed case of OSMF, with restricted mouth opening and burning sensation in the oral cavity. He received intralesional betamethasone injection (4mg/ml) in buccal mucosa biweekly at a private dental clinic. Two weeks after commencement of the treatment, he developed pain along with swelling in relation to bilateral cheek region. The condition worsened after the third week(6 injections). An ultrasound scan was done which suggested the presence of an abscess. Following aspiration, incision and drainage was done, and empirical antibiotic therapy was initiated. The pus aspirated during the surgical procedure was sent for culture but did not show the presence of any organism, prompting a diagnosis of a sterile abscess. The patient recovered well without any further recurrence. Although steroids are most popular and frequently used drug used for the treatment of OSMF, however, it is important to keep in mind that it is a “double-edged sword”. When used in proper dosage at regular intervals, it will give excellent beneficial results, but a clinician must be aware of its rare complication as manifested in this case. Intralesional steroid injection is one of the commonly used modalities for the symptomatic relief of burning in OSMF. Hence, awareness of any complications associated with the same, whether common or rare, is essential for the early identification and management.