C43-53 Ludwig’s Angina Presenting as Pericarditis

Abstract Ludwig’s angina (LA) is a severe cellulitis affecting the submandibular, sublingual, and submental spaces. We report a rare case of LA initially presenting as pericarditis, later progressing to descending necrotizing mediastinitis (DNM) in a previously healthy adult. This case highlights the importance of early imaging, airway management, and prompt surgical drainage for a favorable outcome. A 30-year-old female presented to the emergency department (ED) with acute pericardial symptoms and neck swelling. Eight days prior, she had sustained bilateral mandibular fractures but had declined both intravenous antibiotics and surgical intervention. Upon examination and initial CT imaging in the ED, phlegmonous inflammation and fluid collections were observed in the submental and submandibular spaces, extending into the sternocleidomastoid muscles and mediastinum. Despite receiving IV antibiotics, the patient developed a complicated parapneumonic effusion, resulting in complete left lung collapse, which was confirmed by bronchoscopy.In response, emergent incision and drainage (I&D) was performed, followed by placement of a left chest tube. The patient was transferred to the surgical intensive care unit (SICU) and later referred to a tertiary care center for possible lung decortication. At the center, she underwent drainage of a right neck abscess, insertion of a right chest tube, and mediastinal drainage via a posterolateral thoracotomy. On day 4 of admission, she returned to the operating room for drainage of a right supraclavicular abscess. Following these procedures, her clinical status improved significantly. Antibiotics were switched to Augmentin, chest tubes were removed, and the patient was ultimately discharged home in stable condition.Ludwig’s angina (LA) is a rapidly progressing cellulitis that can lead to life-threatening complications such as empyema or, more critically, descending necrotizing mediastinitis (DNM). This case presents a rare and striking progression of LA, initially manifesting as pericarditis in a previously healthy adult, which swiftly escalated to DNM, as confirmed by CT imaging showing extensive mediastinal involvement. The exceptional nature of this case lies in the rapid progression from local infection to severe mediastinal sepsis, highlighting the critical importance of early diagnosis and multidisciplinary management. Timely airway management, aggressive antibiotic therapy, and surgical drainage were pivotal in averting further complications. This case serves as a powerful reminder that heightened clinician awareness and prompt intervention are essential in preventing catastrophic outcomes, underscoring the need for vigilance in similar cases to optimize patient prognosis. This abstract is funded by: None