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

Ludwig’s Angina in Diabetic and Tuberculosis Patient

Abstrak

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.