A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space neck infection. Triage vitals are remarkable for a heart rate of 118 beats per minute. She is otherwise normotensive and afebrile. On physical exam, slight crepitation in noted on the floor of the patient’s mouth. Of note, the patient also informs you of her penicillin allergy. Which of the following is the biggest risk factor for this particular disease process? A) Parotitis B) Dental Infections C) Peritonsillar Abscess D) Immunocompromised State

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Looking like Ludwig's angina following dental infections. Answer is B Treatment is Maintain airway Trachestomy if necessary Antibiotics to treat underlying tooth infections
An emergent CT scan and ENT consultation were obtained in the ED. The patient did not require any airway intervention. The CT scan confirmed the presence of Ludwigs angina and the patient was started on an IV antibiotic regimen and IV dexamethasone in the ED. Given the patients penicillin allergy, the patient was started on vancomycin, aztreonam, and metronidazole. The patients clinical symptoms improved and the patients blood cultures grew Streptococcous anginosus. The patient was discharged home after a week-long stay in the hospital and continued to improve when seen by the ENT specialist as an outpatient. Interestingly, the patient did not have a dental source of her infection and the nidus for the infection continues to remain unclear.
Most probably it is a case of an immunocompromised patient having taken for a long time corticosteroid due to asthma followed by cellulitis of the sublingual spaces.
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B) dental infection Ludwig angina
its a case of b) Ludwigs angina
Ludwigs Angina. It is a life threatening emergency mostly caused by pathology of inferior molars and should be managed in a high dependecy ICU. As facials planes are involved, it can spread rapidly if the patient is immunocompromised. Treatment is I/V Antibiotics Surgical drainage may be oral or outside. Careful monitoring of respiration.
The location of infection rises suspicion of thyroid abscess. This can cause odynophagia and hoarseness . Neck ultrasound should have been done to confirm.Ludwigs will look more deep and diffuse swelling in anterior upper neck just below jaw ,here it's more localised to the middle of neck.
IT'S A CASE OF PERITONSILLAR ABCESS WITH INVOVEMENT OF THE LARYNGEAL CARTILAGES AND SURROUNDING TISSUES , DUE TO WHICH PT. HAD PAIN DURING SWELLOWING , TO WHICH LUDWIG ANGINA IS THERE .THERE MAY BE THYRODITIS ASSOCIATED WITH INVOLVEMENT OF LEFT LARYNGEAL NERVE.
the illness is Ludwigs angina & the biggest risk factor appears D--immunocompromised state
b dental infection as it is case of Ludwig angina
B. Case of Ludwigs angina
yes sir
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