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Extrapulmonary tuberculosis and COVID-19 infection coexisting in concurrent necrotising fasciitis with deep space infection of neck: an unusual presentation
  1. Subham S Agarwal1,
  2. Hafiz Md Nasimuddin Ansari1,
  3. Santhosh Rao1 and
  4. Virat Galhotra2
  1. 1Dentistry—Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
  2. 2Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
  1. Correspondence to Dr Santhosh Rao; santhosh{at}


Ludwig’s angina is a rapidly spreading, potentially fatal infection of deep fascial spaces of the neck leading to airway oedema and death. This, in recent times when associated with COVID-19 infection, possess treatment challenges making the patient susceptible to opportunistic infections with reduced healing potential. Owing to the multifactorial aetiology in our case and addressing them at the earliest, it is important to achieve favourable outcomes. The space infection that seeded with untreated trivial dental caries progressed to necrotising fasciitis of neck with mycobacterial growth on cartridge-based nucleic acid amplification test for tuberculosis testing. The presence of Mycobacterium organisms should be speculated in patients with pulmonary signs of tuberculosis (TB) because a suppurative TB lymphadenitis of neck could also have the same presentation. The decisive moment in successful outcome was identification of mycobacteria in COVID-19 infected patient, thereby allowing to initiate the antitubercular therapy along with surgical debridement. Thus, medical management of patient with cohabiting infections is difficult task and needs appropriate addressal.

  • Immunology
  • Oral and maxillofacial surgery
  • Tuberculosis
  • Pathology
  • Drugs: infectious diseases

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  • Contributors SA wrote the initial manuscript and did literature search. HMNA did the proofreading and documentation. SR was the operating surgeon and final proofread the manuscript, literature search. VG did the literature search and documentation.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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