Group A streptococcal pharyngitis and bacteremia associated with a Ludwig's angina-like syndrome

Ludwig's Angina (LA) is an infection of the submandibular and sublingual spaces usually initiated by abscesses of the inferior molars due to mixed oral flora. Pharyngitis due to group A beta-hemolytic streptococci (GABHS) rarely results in bacteremia. A patient presented with the classical findings of LA, and had no odontogenic focus but had GABHS pharyngitis and bacteremia. Attempts to isolate other microbiological organisms from the submandibular and sublingual spaces were unsuccessful. The patient required emergent tracheostomy and was treated with penicillin G for 4 wk with complete resolution of his clinical illness. The case demonstrates a previously unreported association between GABHS pharyngitis and the development of LA.