This is a 30-year-old female patient who attends the emergency service of CBMF-HGO in regular general conditions presenting dyspnea, dysphagia, odynophagia, tachypnea, mouth opening and cervical dysphonia 15
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Intraoral clinical examination revealed partial maxillomandibular edentulism, 4.8 with advanced caries, poor oral hygiene and moderate increase in the volume of the floor of the mouth that produces glossoptosis.
The admission paraclinical tests reported leukocytosis with 22.800 U/mm3 due to the presence of neutrophils, hemoglobin of 12 g/dl, hematocrit of 35.3% and glycemia of 123 g/dl.
A computed tomography is indicated that shows multiple images hypodense a thoracic level of the sublingual space, bilateral submandibular and submental communicated with the right supraclavicular region and retrostinal to the left lower airway lumen with displacement of the region.
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Definitive diagnosis: Ludwig's angina complicated with congenital syphilis.
Interconsultation with the Infectious Diseases and Internal Medicine Services initiated intravenous antibiotic treatment with vancomycin 1 gr every 12 h, clindamycin 600 mg every 8 h and meropenem 1 g.
A surgical drainage of the submandibular, bilateral sublingual and submental spaces is performed, composing them and establishing a passive drainage of the penrose type.
Given the cervicothoracic extension, the General Surgery team complemented the surgical drainage act in the right supraclavicular region, leaving similarly a dren penrose.
Three lavages were performed daily with 1,000 cc of saline solution.
In post-surgical airways and therapeutic interventions implemented in the patient, there was a clinical improvement, showing a decrease in volume and worsening in control CT scans.
Two weeks after surgical drainage, the patient presented laboratory values of white blood cells with 6,580 U/mm3, hemoglobin of 12.8 g/dl, hematocrit of 39.6% and clinical improvement of the initial symptoms.
