LUDWIG'S ANGINA ASSOCIATED TO CHEMICAL STOMATITIS DUE TO COCAINE USE

Abstract

A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation. A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation.