A 65 year old man with htn presents after being woken up from sleep with trouble breathing. His breathing improved after he sat up, but he is still complaining of tongue swelling.
On exam, he has poor dentition, fullness to his upper neck and submandible area, and drooling. He denies fevers, chills, taking an ACE inhibitor, new foods, previous allergic reactions.
What are you worried about for this patient?
LUDWIG’s ANGINA
How do you diagnose this?
CT scan with IV contrast
How do you treat this?
Antibiotics. Usually polymicrobrial related to poor dentition. May be MRSA! Treatment options include unasyn,clindamycin, zosyn, +/- vancomycin.
Anything else you're worried about?
These patients can have rapidly expanding infections and edema leading to significant airway compromise. They might need to be preemptively intubated! One case series mentioned in Tintinalli’s reports that 11/20 patients could not be intubated and needed emergently tracheotomy.
By Dr. Andrew Grock and Soon-to-be Chief Sally Bogoch.
Special thanks to Dr. Jimmy James Willis
References
Tintinalli’s 7th ed.
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