Diagnostic challenges in identifying Ludwid’s angina with complicated comorbidities of diabetic and tuberculosis patient in emergency settings: a case report
Ludwig’s angina in diabetic and tuberculosis patient
Keywords:
Ludwig’s angina, diabetes mellitus, tuberculosis, airway obstruction, SOFA ScoreAbstract
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. Case presentation: A 43-year-old male with a history of uncontrolled DM and tuberculosis presented with a 4–5 months progressive swelling and pain in the right submandibular area, worsening in the last week. Physical exam showed an indurated, warm, erythematous mass, limited neck movement, and poor dental hygiene. Labs 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, requiring referral to a tertiary care center 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.
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