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Severe Ludwig’s angina caused by an unknown insect bite
  1. Gihad Almadhi1,
  2. Mohammed Alkathlan2,
  3. Othman Alharbi1 and
  4. Ahmad Almeman1
  1. 1College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
  2. 2Infectious Diseases, King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia
  1. Correspondence to Dr Ahmad Almeman; ahmadalmeman{at}


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.

  • emergency medicine
  • intensive care
  • medical management
  • ear
  • nose and throat/otolaryngology

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  • Contributors GA is the primary author and had full access to all data and drafted the manuscript. MA was the principle physician of the case. OA collected and provided the case data and obtained the patient’s consent. AA supervised the report and the publication process. All authors read and confirmed the final version of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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