A Rare Case Report of Ludwig’s Angina: Early Detection and Prevention of Airway Catastrophe

Abstract

Background: Ludwig’s angina is infection of the soft tissue or gangrenous cellulitis, starting from the floor of mouth or base of the tongue. It can then directly spread to the soft tissue of neck, result in significant oedema and distortion of the adjacent airway, yielding fatal airway obstruction. Case Report: We report a case of 29 year old female who presented to our emergency department with sore throat for 2 weeks, fever for 12 days, progressively increasing pain in throat for 1 week. She was unable to swallow any solid as well as liquids since last night. In our case we picked up a diagnosis of Ludwig’s Angina quite early as we kept a high threshold of suspicion secondary to subtle signs of an impending airway problem: change in patient’s voice and subtle swelling of her chin described by the patient herself. A CT neck & floor of mouth confirmed our clinical suspicion and diagnosis of Ludwig's Angina. We managed her with aggressive early intravenous (IV) antibiotics, IV steroids and IV hydration and could prevent a fatal airway complication to transpire. Why Should an Emergency Physician Be Aware of This? We, the authors believe that every emergency physicians must be aware of Ludwig’s Angina, though a rare condition but can give rise to fatal airway obstruction and airway management mishaps in emergency departments. We highlighted the importance to recognise early signs of threatened airway, which can be subtle to begin with and easily be missed, if not a very high suspicion, which only comes from being perspicacious about this condition. Early diagnosis and management can reduce mortality and morbidity significantly.