Ludwig's Angina in a Pediatric Patient: A Case Report

Ludwig's angina (LA) is a life-threatening, rapidly progressive infection of the submandibular, sublingual, and submental spaces, often caused by odontogenic infections. We report the case of an eight-year-old previously healthy girl who developed LA following untreated dental caries. She presented with a four-day history of odontalgia, left hemifacial edema, and trismus. Despite an initial course of oral amoxicillin-clavulanate, her condition worsened, leading to hospital admission. Examination revealed fever (38.1°C), painful left submandibular swelling, trismus, and molar caries. Laboratory tests showed leukocytosis, neutrophilia, and elevated C-reactive protein (CRP), suggesting severe infection. Intravenous amoxicillin-clavulanate and clindamycin were initiated, but symptoms progressed with increasing pain, sublingual swelling, and worsening trismus. A cervical CT confirmed an abscess in the left sublingual space with extensive periradicular lytic lesions. Urgent surgical intervention included extraction of teeth 36 and 75 and abscess drainage, which revealed purulent material. Postoperatively, the patient improved with a 14-day antibiotic course, resolving fever and swelling. This case underscores the importance of early recognition and prompt treatment of LA in pediatric patients. Multidisciplinary management is essential for optimal outcomes. Additionally, vigilant dental care and good oral hygiene are key to preventing odontogenic infections and severe complications.