Ludwig's angina after severe thrombocytopenic purpura associated with dengue fever

Abstract

Here, we report a case of Ludwig's angina, which required surgery because of toothache. The patient had dengue and severe thrombocytopenia as confi rmed by clinical and laboratory diagnoses. However, dengue is not included among the predisposing factors for Ludwig's angina.

Ludwig’s Angina: Emergency Treatment

“…In keeping with this notion, hospitalization should be taken as the initial measure, and treatment should be based on three important aspects that include upper airway maintenance, drainage or surgical decompression, and intravenous antimicrobial therapy. 2 Airway management is the foundation of treatment for patients with Ludwig's angina. Recommended techniques include routine incision and drainage, orotracheal intubation, and fiber-optic nasotracheal intubation.…”

“…Ludwig's angina was coined after the German physician, Wilhelm Friedrich von Ludwig, who first described this condition in 1836 as a rapidly and frequently fatal progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. 2 Other synonyms include angina ludovici, cynanche, carbuculus gangraenosus, morbus strangulatorius and angina maligna. 3 Despite the recent advances in therapy, rare and potentially life-threatening complications may still arise from time to time, and, as a result, account for significant morbidity and mortality.…”

Authors Reply

“…The concomitant disorder between dengue and thrombocytopenic purpura is not common and can be problematic. This problem can induce to severe bleeding as well as atypical manifestations such as angina 2 . To manage those cases, adding to fluid replacement therapy, steroid therapy seems to be useful 6 .…”