Department of Urology, CHU, Poitiers, France; Department of Infectious Disease, CHU Hôtel Dieu, Nantes, France; CIC 1413, INSERM, France.
Department of Infectious Disease, CHU Hôtel Dieu, Nantes, France; CIC 1413, INSERM, France; Department of Medical Intensive Care, CHU Hôtel Dieu, Nantes, France.
Int J Infect Dis. 2020 Apr;93:160-162. doi: 10.1016/j.ijid.2020.01.028. Epub 2020 Jan 23.
Ludwig's angina has been known for two centuries as a rapidly and frequently fatal progressive gangrenous cellulitis or necrotizing fasciitis of the neck and the floor of the mouth. The management of the usually young patients affected requires a trained team combining medical skills in surgery, antibiotic therapy, and resuscitation. The prognosis is directly related to early surgical debridement and the experience of the team managing these patients. We present four cases of severe necrotizing cervical cellulitis notably associated with concomitant self-medication with non-steroidal anti-inflammatory drugs. Through these cases, we conclude that several surgical steps could be required, combined with broad-spectrum antibiotic therapy. An optimal surgery, draining all collections and excising all necrotic tissues, seems to be a condition needed for antibiotic efficacy and finally healing.
路德维希咽峡炎作为一种快速且经常致命的进行性坏死性蜂窝织炎或颈部和口腔底部的坏死性筋膜炎，已经被人们认识了两个世纪。通常影响年轻患者的治疗需要一个训练有素的团队，该团队结合了手术、抗生素治疗和复苏方面的医疗技能。预后与早期手术清创和管理这些患者的团队的经验直接相关。我们报告了 4 例严重的坏死性颈蜂窝织炎病例，这些病例明显与同时使用非甾体抗炎药自我治疗有关。通过这些病例，我们得出结论，可能需要几个手术步骤，结合广谱抗生素治疗。一种最佳的手术方法，即引流所有脓肿并切除所有坏死组织，似乎是抗生素疗效和最终愈合的必要条件。
