Ludwig's Angina: An Uncommon Cause of Chest Pain

Marí Elena Ocasio-Tascó, MD; Miriam Martínez, MD; Arturo Cedeño, MD; Alfonso Torres-Palacios, MD; Edwin Alicea, MD; William Rodríguez-Cintró, MD

Disclosures

South Med J. 2005;98(5):561-563. 

In This Article

Abstract and Introduction

A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. Neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, Ludwig's angina remains a potentially lethal infection in which early recognition plays a crucial role.

Ludwig's angina is a progressive submaxillary cellulitis of the floor of the mouth, usually polymicrobial, which spreads to adjacent tissues.[1] Most cases occur in healthy hosts, but it has been associated with underlying diabetes mellitus, systemic lupus erythematosus, and neutropenia. Other predisposing factors include poor dental hygiene, intravenous drug abuse, trauma, and tonsillitis.[2—5] It usually results from an odontogenic infection. This case report is used to illustrate an atypical presentation of Ludwig's angina.

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