Diagnostic Challenges in Identifying Ludwig’s Angina with Complicated Comorbidities in a Diabetic and Tuberculosis Patient in Emergency Settings: A Case Report

2025-11-27T03:06:56+00:00

Background: Ludwig’s angina (LA) is a rapidly spreading infection of the submandibular, sublingual, and submental spaces that involves the floor of the mouth and may lead to airway compromise and sepsis. Predisposing factors such as dental infections, diabetes mellitus (DM), and immunocompromised conditions (e.g., tuberculosis) increase the risk and complicate management. Objective: To present a rare and severe manifestation of Ludwig's angina in a patient with uncontrolled DM and active TB, highlighting the synergistic effects of these comorbidities and underscoring the importance of early diagnosis, multidisciplinary care, and evidence-based intervention. Case: A 43-year-old male with a history of uncontrolled DM and tuberculosis presented with a 4–5 month progressive swelling and pain in the right submandibular area, worsening in the last week. Physical examination showed an indurated, warm, erythematous mass, limited neck movement, and poor dental hygiene. Discussion: Laboratory results revealed leucocytosis, elevated liver enzymes, hyperglycaemia, and chest X-ray suggesting pulmonary TB. SOFA score was calculated to assess the severity of systemic involvement. The patient received oxygen, IV antibiotics, insulin, and was referred for surgical debridement. Due to hemodynamic instability and complex comorbidities, the patient required referral to a tertiary care centre for definitive airway and surgical management. Conclusion: Ludwig’s angina in patients with DM and TB requires rapid multidisciplinary management. Delay increases morbidity and risk of airway obstruction or sepsis.

Avascular Necrosis of the Femur Head after the Installation of Internal Fixation of the Posteriol Wall of the Acetabulum: A Case Report

2025-11-26T03:02:54+00:00

Background: One of the most common acetabular fracture was the posterior wall of the acetabulum, with the complication of avascular necrosis (AVN) of the femoral head. Several factors influence the development of AVN, including the severity of the trauma, delays in treatment, and the type of surgical intervention chosen.

Objective: To describe a patient with a posterior wall acetabular fracture with further developed to AVN for six months, and followed by an open reduction and internal fixation (ORIF).

Case: A 63-year-old male patient visited the RSD Dr. Soebandi Clinic in Jember for a follow-up after undergoing ORIF on his right acetabulum due to acetabular rim fracture. He reported experiencing pain and stiffness in his right groin for the past two weeks; however, he noted that the pain had subsided, and he had regained mobility. The patient smokes 1-2 packs of cigarettes daily, has no history of long-term steroid use, and does not consume alcohol. As a result of his condition, he underwent total hip arthroplasty and reconstruction. One year after the surgery, the patient was able to walk, and there was an improvement in his Harris hip score.

Conclusion: The fracture of the posterior wall of the acetabulum is a serious injury that can lead to several complications, including avascular necrosis (AVN). Total hip replacement (THR) is the preferred surgical treatment for patients with AVN when the femoral head and acetabulum are no longer viable. Patients with AVN who have undergone THR have shown positive outcomes in this and previous studies.

Surabaya Medical Journal

Diagnostic Challenges in Identifying Ludwig’s Angina with Complicated Comorbidities in a Diabetic and Tuberculosis Patient in Emergency Settings: A Case Report

Avascular Necrosis of the Femur Head after the Installation of Internal Fixation of the Posteriol Wall of the Acetabulum: A Case Report