Osteosarcoma presenting as ludwig’s angina in a down’s syndrome patient: A case report

Individuals with Down's Syndrome are predisposed to leukaemia, possibly other malignancies, various infection as well as increased mortality from other causes. osteosarcoma has been linked to genetic illnesses such as hereditary retinoblastoma, Li-Fraumeni syndrome, and Rothman-Thomson syndrome, it has not been linked to Down syndrome. Treatment plan for osteosarcoma includes surgical resection with systemic chemotherapy. Osteosarcoma is highly resistant to radiotherapy. Here we present a 21 year old female patient which is a unique case of Osteosarcoma in Down’s Syndrome patient presenting as Ludwig’s Angina. This current report highlights a clinical presentation of Osteosarcoma in Down’s Syndrome.

Case Report: Poor oral hygiene leading to an emergency condition: A case report of Ludwig’s angina

Ludwig’s angina (LA) is a rapidly spreading and potentially life-threatening infection having an odontogenic infection as the most common source. It involves the floor of the mouth and neck. Modernization in medical care has made this entity rare and of low mortality at the present but it is still feared as a lethal entity due to rapidly progressive airway obstruction that follows. Here we report a case of a 15-year-old male who suffered from LA. Presenting symptoms and findings of the examination helped in the clinical diagnosis. Immediate intubation, use of broad-spectrum antibiotics, and treatment of complications aided the patient’s recovery. LA should be considered for differential diagnosis in the case of neck swelling especially in those having a history of poor oral hygiene and recent dental procedures. Management of LA and its complications should always involve doctors from multiple disciplines.

Severe Ludwig’s angina caused by an unknown insect bite

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

Association of qSOFA with Ludwig's Angina Patient Mortality at Dr. Sutomo Hospital, Surabaya

Objective: This study aims to determine the association between The quick Sequential Organ Failure (qSOFA) score and the mortality of Ludwig's Angina. Material and Methods: Secondary data from the medical records of Ludwig’s Angina patients in the period January 2019 - December 2020. Data included demographic feature, qSOFA data, Outcome patient, comorbidity diseases and complications before treatment. The number of samples was determined using the total sampling method. This study was enrolled into analytical observational study. Results: There were 49 medical records that were included in the inclusion criteria, 6 medical records were excluded because the data were missing. There were more men 36 (73,5%) than women 13 (26,5%). There were 12 (24,5%) high qSOFA and 37 (75,5%) low qSOFA. There were 12 (24,5%) patient outcome dead and 37 (75,5%) outcome alive. The results of Chi-square analysis show qSOFA and confounding Diabetes Mellitus (DM) respectively were statistically significant association with Ludwig's Angina mortality. The results of multivariate logistic regression analysis, shows that there is a significant association between qSOFA and Ludwig's Angina mortality (p: 0.018) with an OR of 20.9 (CI 95% : 1,673 – 263,367). Diabetes mellitus comorbidity factors were also significantly associated with the mortality of Ludwig's angina. Conclusion: There is a significant association between qSOFA and Ludwig's Angina mortality. Keywords: Ludwig’s Angina, Mortality, qSOFA, Sepsis.