Abstract
A 42-year-old female with a toothache, fever, submandibular and neck swelling was initially misdiagnosed to have flu by local medical institutions, however, her symptoms deteriorated and she was thereafter transferred to our hospital. On arrival, she demonstrated septic shock. As her neck and chest CT indicated pyothorax with submandibular and mediastinal abscesses, she thereafter underwent a neck incision, a tracheotomy and bilateral tube thoracostomies. An investigation of her oral cavity disclosed a dilation of the opening of the submandibular duct. Accordingly, she was diagnosed to have Ludwig's angina due to the development of a salivary duct stone, thus resulting in descending mediastinitis, pyothorax and septic shock. Multidisciplinal approaches, such as mechanical ventilation, antipyretic drugs and multiple CT guide drainage for multicapsulated pyothorax resulted in an improvement of her symptoms. She was discharged on foot on the 58th hospital day. Ludwig's angina is a submandibular abscess mainly induced by dental caries. When the infection spreads through oto-pharyngeal loose connective tissue, it can cause meningitis, descending mediastinitis and pyothorax. Ludwig's angina is rare, however, it can be lethal. Therefore, physicians should include the possibility of Ludwig's angina in the differential diagnosis when encountering a patient demonstrating submandibular swelling with inflammation signs.
