A 35-year-old male presented with lower gum pain associated with fever, chills, and sore throat. His medical history included intravenous drug use, human immunodeficiency virus infection, and hepatitis C. Physical exam revealed tachycardia, a temperature of 38.9°C, anterior cervical lymphadenopathy, halitosis, an edematous lower lip, and purulent ulcers anterior and posterior to lower central incisors with marked tenderness and erythema (Figure). His laboratory work was notable for a low white blood cell count (2.6 thousand/µl), neutropenia (0.11 thousand/µl), a low absolute CD4 lymphocyte count (0.5 thousand/µl), and elevated C-reactive protein (129mg/L) and sedimentation rate (23mm/hr). A computed tomography study showed a 0.5×1.3×0.3cm abscess anterior to the mandibular symphysis.