CERVICOFACIAL NECROTIZING FASCIITIS EVOLVING FROM LUDWIG’S ANGINA IN PATIENT WITH ACUTE LYMPHOCYTIC LEUKEMIA: A CASE REPORT

Abstract

Ludwig’s angina is a cellulitis affecting the submandibular region, which in most cases arises from an acute infection of lower molars. In immunocompromised patients, it can spread through cervical fascia, leading to cervicofacial necrotizing fasciitis. A 28-year-old male patient was admitted to an emergency department because of mandibular and neck swelling. Medical history showed acute lymphocytic leukemia. Physical examination showed anterior projection of tongue, limitation of buccal opening, dyspnea, dysphagia, and toxic-looking appearance. In the right mandibular region, a fistula was noticed. There was a necrotic area going from the mandible’s base to the chest. Intraoral examination showed a residual root of first inferior molar. Cervicofacial necrotizing fasciitis evolving from Ludwig’s angina due to odontogenic abscess was established. Broad-spectrum antibiotic treatment was initiated. The residual root was removed without complications. After control of fasciitis, a skin graft was performed. The patient died a few weeks later of pulmonary complications. Ludwig’s angina is a cellulitis affecting the submandibular region, which in most cases arises from an acute infection of lower molars. In immunocompromised patients, it can spread through cervical fascia, leading to cervicofacial necrotizing fasciitis. A 28-year-old male patient was admitted to an emergency department because of mandibular and neck swelling. Medical history showed acute lymphocytic leukemia. Physical examination showed anterior projection of tongue, limitation of buccal opening, dyspnea, dysphagia, and toxic-looking appearance. In the right mandibular region, a fistula was noticed. There was a necrotic area going from the mandible’s base to the chest. Intraoral examination showed a residual root of first inferior molar. Cervicofacial necrotizing fasciitis evolving from Ludwig’s angina due to odontogenic abscess was established. Broad-spectrum antibiotic treatment was initiated. The residual root was removed without complications. After control of fasciitis, a skin graft was performed. The patient died a few weeks later of pulmonary complications.