Ludwig ’s angina

A 77-year-old, male patient with type 2 diabetes mellitus presented with a 3-day history of progressive, painful, submandibular swelling. On presentation, his appearance was toxic, and his vital signs were temperature 38.3 °C (100.9°F), heart rate 122 beats per minute and blood pressure 77/50 mm Hg. A physical examination revealed a tender, erythematous swelling in the submandibular space (Figure  1A) and caries of the right mandibular molar. Laboratory tests demonstrated elevated inflammatory markers, elevated creatine kinase and acute kidney injury. Based on these findings, Ludwig ’s angina was clinically diagnosed, and the patient promptly received intravenous antibiotics and a surgical incision. Later, two sets of blood culture on admission were found to have grownParvimonas micra. Magnetic resonance imaging performed on hospital Day 7 revealed submandibular cellulitis (Figure  2) and submandibular osteomyelitis. One month later, his symptoms resolved (Figure  1B).
Source: QJM - Category: Internal Medicine Source Type: research