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A rare case of Ludwig’s angina after viper bite
  1. Yeow Hoay Koh
  1. Department of Neurology, National Neuroscience Institute of Singapore, Singapore General Hospital, Singapore, Singapore
  1. Correspondence to Dr Yeow Hoay Koh, kohyeowhoay{at}

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A previously healthy 20-year-old woman presented to our Accident and Emergency Department of Degehbur Hospital, a small district hospital in Somali region of Ethiopia, with complaints of rapidly progressive swelling in her neck and difficulty in swallowing for the past 2 days (figures 1 and 2). She was bitten by a snake, which was later identified as a viper, over her right lower jaw while sleeping on the floor. She did not seek any medical treatment until day 3 when the swelling became worse and involved both submandibular region and the tongue. She also complained of rapidly increase shortness of breath for the past 24 hours.

Figure 1

The patient presented to emergency department with severe swelling of her tongue, neck and submandibular area.

Figure 2

Lateral view of the patient showing severe submandibular swelling that obscuring the airway.

On arrival at the accident and emergency department, she had noisy breathing, drooling of saliva and difficulty in closing her mouth. There was diffuse swelling over both of her submandibular …

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