Apixaban-Induced Pseudo-Ludwig's Angina

Area of Science:

• Otolaryngology
• Emergency Medicine
• Pharmacology

Background:

• Ludwig's angina is a severe bacterial infection of the floor of the mouth.
• Pseudo-Ludwig's angina involves noninfectious sublingual swelling, often mimicking the original condition.
• Sublingual hematomas from anticoagulants like warfarin are rarely reported.

Observation:

• A case of pseudo-Ludwig's angina was observed.
• The patient's condition was induced by apixaban, a novel anticoagulant.
• The presentation mimicked the severe airway compromise seen in Ludwig's angina.

Findings:

• Apixaban was identified as the causative agent for the pseudo-Ludwig's angina.
• Urgent surgical intervention was required for management.
• Supportive care included antibiotics and glucocorticoids.

Implications:

• This case expands the differential diagnosis for acute upper airway obstruction.
• It highlights the potential for apixaban to cause significant bleeding complications, including sublingual hematoma.
• Early recognition and prompt management are crucial for favorable outcomes in pseudo-Ludwig's angina.