Sakhuja Anuradha, Shrestha Dhan B, Aryal Barun B, Mir Wasey Ali Yadullahi, Verda Larissa
Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA.
Department of Emergency Medicine, B.P. Smriti Hospital, Kathmandu, NPL.
Cureus. 2022 Jun 12;14(6):e25873. doi: 10.7759/cureus.25873. eCollection 2022 Jun.
Ludwig's angina is the rapidly progressive cellulitis of the soft tissue of the neck and the floor of the mouth. Airway compromise is a frequent and potentially fatal sequela of Ludwig's angina. Here we present a case of a 54-year-old African American male who presented with fever associated with painful swelling of the mouth and anterior neck. He was febrile and hypoxic on presentation. Imaging showed extensive involvement of the neck and mediastinum to the level of the clavicles. The diagnosis of Ludwig's angina of periodontal origin was made, and intubation was performed for airway protection. Management was done by surgical debridement along with a course of broad-spectrum antibiotics. The patient's condition improved, and he was discharged on oral antibiotics with a referral to a dentist. Our case demonstrates that early diagnosis, airway management, treatment with broad-spectrum antibiotics, and surgical intervention are vital for the successful management of severe cases of Ludwig's angina.
路德维希咽峡炎是一种颈部软组织和口腔底部迅速进展的蜂窝织炎。气道受压是路德维希咽峡炎常见且可能致命的后遗症。在此,我们报告一例54岁非裔美国男性病例,该患者因口腔和颈部前部疼痛性肿胀伴发热前来就诊。就诊时他发热且缺氧。影像学检查显示颈部和纵隔广泛受累至锁骨水平。诊断为牙周源性路德维希咽峡炎,并为保护气道进行了插管。通过手术清创并联合使用一个疗程的广谱抗生素进行治疗。患者病情好转,出院时口服抗生素,并转诊至牙医处。我们的病例表明,早期诊断、气道管理、广谱抗生素治疗以及手术干预对于成功治疗严重的路德维希咽峡炎病例至关重要。