Ludwig's angina in a 76-year-old man

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Head and Neck Surgery

Background:

• Ludwig's angina is a rapidly progressive, bilateral cellulitis of the submandibular, sublingual, and submental spaces.
• It classically presents in younger patients with a history of dental infections or recent dental procedures.

Observation:

• A 76-year-old male presented with a 24-hour history of tense, tender midline neck swelling.
• Computed tomography confirmed Ludwig's angina, leading to respiratory compromise and ICU admission.
• The patient developed an abscess requiring surgical drainage under general anesthesia.

Findings:

• This case demonstrates Ludwig's angina in an elderly patient without the typical preceding dental issues.
• The condition led to significant airway compromise, necessitating intensive care unit management.
• Abscess formation complicated the clinical course, requiring operative intervention.

Implications:

• This case underscores the importance of considering Ludwig's angina in elderly patients presenting with neck swelling, even in the absence of typical risk factors.
• It highlights the potential for rapid airway compromise and the need for prompt emergency department evaluation and management.
• Early recognition and intervention are crucial for favorable outcomes in this uncommon but potentially life-threatening condition.