A parotid abscess is a rare condition often associated with immunocompromised status. ESRD is known to increase the risk of infections (DNI), two-fold. Parotid abscess in patients with ESRD may behave aggressively with extension into adjacent spaces and facial paralysis. Management of infections in patients with ESRD is challenging and often dictates a modification of the usual treatment strategies because of alterations in their protein binding, volumes of distribution, kidney clearance, and non-renal clearance. Facial palsy associated with parotid abscess is rare with only a few reports in the literature.The exact etiology and mechanism of this palsy are unknown however compression of the nerve is the most suspected cause. Although corticosteroids and physiotherapy are proposed treatment modalities for faster recovery of nerve function, there are no clear guidelines for the same. Here, we report a case of a patient with parotid abscess and facial paralysis, with underlying ESRD and uncontrolled diabetes, on dialysis for the past 15 years. Incision and drainage were performed under local anesthesia due to the patient's high-risk status. Suitable antibiotic therapy was administered after confirming the renal safety of the doses. Four weeks post-presentation, the patient was asymptomatic with partial recovery of the paralysis.