LUDWIG's angina in patient with cushing's syndrome: report of a case

Lee, Dong Keun; Kim, Yong Woan; Lee, Eun Young; Park, Hwa Kyu

Abstract

Ludwig's angina is a serous and potentially life threatening infectious disease involving all of the submental, submandibular, and sublingual space bilaterally. It is characterized by severe swelling and broad-like induration of the tissues in the submandibular region and elevation of the tongue and flood of mouth with partial immobilization of these structures. A common cause of Cushing's disease is an iatrogenic problem related to chronic administration of either ACTH or glucocorticoids. Patients who administrated glucocorticoids altered responese infection and wound healing. More important, many patients who are taking or have been taken glucocorticoids have risk of developing acute adrenal insuffciency (adrenal crisis) when place in stressful situation. The treatment of infections in Cushing's syndrome are reduction of number of microbes through the use of appropriated antimicrobial agents and proper surgical drainage and appropriated airway management and prorer steroids therapy that increased administration of glucocorticoids. In this paper, we report a rare case of Ludwig's angina with Cushing's syndrome. A 45-years old women was referred to our clinic in November 1996 for treatment of infetious disease. Clinical examination of this patient showed a painful swelling of submental space, elevation of tongue and difficulty of respiration or 'Moon Face', 'Bufallo hump', striae of abdomen and ecchymosis of extrmities. We treated through the quickly airway management using blind oroendotracheal intubation, antimicrobial injection of large quantity, increased adminstration of glucocorticoids and proper surgical drainage. And We aquired satisfactory result.