Ludwig's angina complicated by fatal cervicofascial and mediastinal necrotizing fasciitis

Manasia, Anthony; Madisi, Nagendra; Bassily‐Marcus, Adel; Oropello, John; Kohli‐Seth, Roopa

doi:10.1016/j.idcr.2016.03.001

Cited by 13 publications

(16 citation statements)

References 3 publications

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“…In cases that an alternative diagnosis was reached, especially in one that is also infectious and potential life threatening, such as Ludwig’s angina, the practitioner should still keep NF in the differential when the disease course appeared to be atypical. Previous reports have demonstrated that Ludwig’s angina or submandibular space cellulitis may sometimes progress to NF leading to poor outcomes 5 6. Since Ludwig’s angina or other severe cervicofacial infections with abscesses often required operative managements, it is important to include NF on the differential when the expected clinical response did not occur.…”

Section: Discussionmentioning

confidence: 99%

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistantStaphylococcus aureus(MRSA) in a young healthy man

Ran¹,

Hicks

Alexiev

et al. 2018

BMJ Case Rep

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An otherwise healthy 24-year-old man presented with 1 week of fever, facial pain and swelling. He initially sought care at an outside hospital, where he was diagnosed with folliculitis and sent home with oral antibiotics. On arrival at our institution, CT neck was ordered, which demonstrated diffuse submental phlegmon, prompting incision and drainage. After initial improvement, the patient experienced high fevers and increased swelling just 12 hours later. The decision was made to take the patient for operative exploration, and wide debridement was performed due to suspicion for necrotising fasciitis intraoperatively that was ultimately confirmed on final pathology. Final speciation of intraoperative culture demonstrated a clindamycin-resistant and methicillin-resistant strain of Staphylococcus aureus. The patient was managed with intravenous antibiotics, additional debridement and careful wound care. Delayed partial closure of wound was eventually performed once patient showed marked and persistent clinical improvement. The patient was discharged on hospital day 12 with close follow-up.

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Section: Discussionmentioning

confidence: 99%

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistantStaphylococcus aureus(MRSA) in a young healthy man

Ran¹,

Hicks

Alexiev

et al. 2018

BMJ Case Rep

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“…[2] Ludwig's angina is an uncommon, aggressive, rapidly progressing, and fatal infection with high mortality rate if unidentified and not treated appropriately. [34] More than 70% of the cases have odontogenic etiology, while the other causes include foreign body, tonsillitis, epiglottitis, pharyngitis, oral laceration, mandible fracture, endotracheal intubation, traumatic bronchoscopy, malignancy, or surgery.…”

Section: Discussionmentioning

confidence: 99%

Ludwig\'s Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics

Hisham

Sivakumar

Kumar

et al. 2017

Indian Journal of Critical Care Medicine

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A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig's angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole. The patient improved and was discharged after five days of ICU stay and 12 days of hospitalization. This case summarizes the rare incidence of Ludwig's angina with antibiotic adverse reactions. If angioneurotic edema is coincidental with features of Ludwig's angina, it becomes more challenging. Early identification, securing the airway, and antibiotic administration are the keystone to better survival.

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“…As condutas iniciais para casos de AL devem ser rápidas, criteriosas e sequenciais (Manasia, et al, 2016;Pereira, et al, 2019). A manutenção da via aérea é fundamental, devido ao risco de rápida obstrução e, consequentemente, morte (Miller, et al, 2018;Mcdonnough, et al, 2019;Fernandes, et al, 2020).…”

Section: Introductionunclassified

Angina de Ludwig associada a complicações mediastinais: Relato de caso

Barbosa

Negreiros

Neves

et al. 2020

RSD

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A angina de Ludwig, considerada uma emergência médica, é uma infecção que atinge os espaços submandibular, sublingual e submentoniano, apresentando curso de evolução rápida e potencialmente fatal. O objetivo deste relato é descrever o tratamento de um caso de angina de Ludwing, decorrente de infecção dentária, associada a complicações cérvico-faciais e mediastinais. A paciente do sexo feminino apresentava história de aumento de volume na região da região submandibular bilateral e submentoniana, queixas de disfagia e dispneia, além de trismo. O paciente foi tratado inicialmente com drenagem e extração do elemento causador da infecção, 72 horas após a operação, porém a paciente voltou a apresentar dispneia. Para o tratamento dessa complicação, realizou-se cervicotomia associada à antibioticoterapia de amplo espectro. A abordagem terapêutica contendo manutenção das vias aéreas, cervicotomia, antibioticoterapia, bem como a retirada do fator etiológico foi eficaz no manejo deste caso de complicação de angina de Ludwing.

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Ludwig's angina complicated by fatal cervicofascial and mediastinal necrotizing fasciitis

Cited by 13 publications

References 3 publications

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistantStaphylococcus aureus(MRSA) in a young healthy man

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistantStaphylococcus aureus(MRSA) in a young healthy man

Ludwig\'s Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics

Angina de Ludwig associada a complicações mediastinais: Relato de caso

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