Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 3 ( 2017 ) > List of Articles

CASE REPORT

Ludwig\'s Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics

Mundilipalayam Sivakumar, R Senthil Kumar, P Nandakumar

Keywords : hypersensitivity, submandibular infection,Angioneurotic edema

Citation Information : Sivakumar M, Senthil Kumar R, Nandakumar P. Ludwig\'s Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics. Indian J Crit Care Med 2017; 21 (3):179-181.

DOI: 10.4103/ijccm.IJCCM_189_15

License: CC BY-ND 3.0

Published Online: 00-03-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig\'s angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole. The patient improved and was discharged after five days of ICU stay and 12 days of hospitalization. This case summarizes the rare incidence of Ludwig\'s angina with antibiotic adverse reactions. If angioneurotic edema is coincidental with features of Ludwig\'s angina, it becomes more challenging. Early identification, securing the airway, and antibiotic administration are the keystone to better survival.


PDF Share
  1. Bartlett JG. Cervical fascial (Perimandibular) space infections. In: Bartlett JG, Auwaerter PG, Pham PA, editors. John Hopkins ABX Guide. New Delhi: Jones and Bartlett Learning; 2010. p. 117-8.
  2. Manasia A, Madisi NY, Bassily-Marcus A, Oropello J, Kohli-Seth R. Ludwig's angina complicated by fatal cervicofascial and mediastinal necrotizing fasciitis. IDCases 2016;4:32-3.
  3. Quereshy FA, Baskin J, Barbu AM, Zechel MA. Report of a case of cervicothoracic necrotizing fasciitis along with a current review of reported cases. J Oral Maxillofac Surg 2009;67:419-23.
  4. Chueng K, Clinkard DJ, Enepekides D, Peerbaye Y, Lin VY. An unusual presentation of Ludwig's angina complicated by cervical necrotizing fasciitis: A case report and review of the literature. Case Rep Otolaryngol 2012;2012:931350.
  5. Kremer MJ, Blair T. Ludwig angina: Forewarned is forearmed. AANA J 2006;74:445-51.
  6. Costain N, Marrie TJ. Ludwig's Angina. Am J Med 2011;124:115-7.
  7. Furst IM, Ersil P, Caminiti M. A rare complication of tooth abscess – Ludwig's angina and mediastinitis. J Can Dent Assoc 2001;67:324-7.
  8. Montañez MI, Ariza A, Mayorga C, Fernandez TD, Torres MJ. Cross- reactivity in betalactam allergy: Alternative treatments. Curr Treat Options Allergy 2015;2:141-54.
  9. Parthiban SV, Muthukumar RS, Alagappan M, Karthi M. Ludwig's angina: A rare case report. Indian J Multidiscip Dent2012;2:518-21.
  10. Kavarodi AM. Necrotizing fasciitis in association with Ludwig's angina – A case report. Saudi Dent J 2011;23:157-60.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.