Fig. 4 Clinical course of the patient. Even after incisions were made for lesion drainage, a tracheostomy and ventilator management were performed due to the risk of airway obstruction. Prednisolone (30 mg/day) was simultaneously discontinued, and local cleaning and antibiotics were initiated. Fever and swelling of the lower right jaw reduced gradually with improvement of the inflammatory response, and noradrenalin was tapered to discontinuation. The patient had recovered enough to be transferred to a general ward; drain tubes were removed, and antibiotic administration was discontinued. No further relapse was observed, and the patient was discharged on day 43. CRP, C-reactive protein; ICU, intensive care unit; WBC, white blood cell