Necrotising fasciitis of the neck, chest and abdomen arising from odontogenic Ludwig’s angina in a healthy young adult

Odontogenic infections are commonly considered a cause of Ludwig’s angina; their progression to necrotising fasciitis (NF) is rare and often associated with significant morbidity and mortality. We report a case of a previously healthy patient in his 20s, a heavy smoker, who developed extensive cervicothoracic NF after wisdom tooth extraction. He initially presented with neck swelling and pain, with stable vital signs and no airway compromise. Within 24 hours, he deteriorated abruptly with respiratory distress and septic shock. CT showed widespread fascial involvement with emphysema tracking into the mediastinum and bilateral pleural effusion. His Laboratory Risk Indicator for Necrotising Fasciitis score was 7, indicating high risk. He required emergent, extensive, repeated debridement, chest drainage and later thoracoscopy. Cultures predominantly grew Streptococcus anginosus . Despite multiple complications, he fully recovered. This case shows that NF can occur even in young, healthy patients, underscoring the importance of early recognition and aggressive management.