Ludwig's angina: A nightmare worsened by adverse drug reacti
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Case Report:
A 52-year-old obese gentleman initially presented to a local hospital with complaints of fever, shortness of breath for 10 days, and wheezing for the last 3 days. He was a teetotaler with a past history of obstructive sleep apnea and asthma. His body mass index was 32.9. He was treated for acute exacerbation of asthma and referred to our hospital. In the ward, he was treated for asthma exacerbation with oxygen by facemask, nebulization (budesonide, ipratropium, and levosalbutamol), and intravenous hydrocortisone (100 mg for every 8 h). Pulmonary function test showed reversible obstructive airway disease. The patient's condition improved and he was planned to be discharged on the third day from hospital admission. On the day of discharge, he developed fever, trismus, dysphagia, submandibular pain, and swelling in the neck causing airway obstruction.

The patient had enlargement of lymph nodes in the neck and had normal dentition. Examination with fiber-optic laryngoscope revealed congestion of the epiglottis and tongue. Ultrasonography (USG) neck was done which reported enlarged parotid and submandibular glands with cervical lymphadenopathy. The patient became drowsy and was immediately shifted to the Intensive Care Unit (ICU). Suspecting Ludwig's angina, piperacillin/tazobactam (4.5 g for every every six hours) was prescribed...

http://www.ijccm.org/article.asp?issn=0972-5229;year=2017;volume=21;issue=3;spage=179;epage=181;aulast=Hisham
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