Here, we report a case of Ludwig's angina, which required surgery because of toothache. The patient had dengue and severe thrombocytopenia as confirmed by clinical and laboratory diagnoses. However, dengue is not included among the predisposing factors for Ludwig's angina.
Ludwig's angina; Dengue; Thrombocytopenia
| Variable | Reference range, adults | 10 days after presentation of dengue, on admission | 4th hospital day - discharged | 1 week after hospital discharge; readmission - diagnosis of Ludwig's Angina | 4th hospital day - intensive care unit | 13 days after presentation of Ludwig's Angina |
|---|---|---|---|---|---|---|
| Hemoglobin (g/dL) | 11.5-17.0 | 13.5 | 13.7 | 11.8 | 9.1 | 13.3 |
| Hematocrit (%) | 37.0-54.0 | 13.4 | 40.5 | 35.2 | 27.5 | 40.3 |
| White cell count (/mm3) | 4,000-10,000 | 3,600 | 3,700 | 21,500 | 14,900 | 10,500 |
| Differential count (%) | ||||||
| Neutrophils | 40-70 | 37.0 | 68.0 | 81.0 | 76.0 | 73.6 |
| Band forms | 0-4 | 16.0 | 5.0 | |||
| Lymphocytes | 20-50 | 56.0* | 25.0 | 2.0 | 15.0 | 18.9 |
| Monocytes | 1-10 | 6.0 | 6.0 | 1.0 | 6.6 | |
| Eosinophils | 0-6 | 1.0 | 1.0 | 0.9 | ||
| Platelet count (per mm3) | 150,000-400,000 | 1,000 | 12,000 | 1,000 | 11,000 | 63,000 |
| Dengue without warning signs | Dengue with warning signs* * requires strict observation and medical intervention. DSS: dengue shock syndrome; AST: aspartate aminotransferase; ALT: alanine aminotransferase; HCT: hematocrit; CNS: central nervous system. | Severe dengue |
|---|---|---|
| Fever and 2 of the following: | Dengue as defined above with any of the following: | Dengue with at least 1 of the following criteria: |
| Nausea and vomiting | Abdominal pain or tenderness | Severe plasma leakage leading to: |
| Rash | Persistent vomiting | shock (DSS) |
| Aches and pains | Clinical fluid accumulation (ascites, pleural effusion) | fluid accumulation with respiratory distress |
| Leucopenia | Mucosal bleeding | Severe bleeding as evaluated by clinician |
| Positive tourniquet test | Lethargy, restlessness | Severe organ involvement |
| Liver enlargement > 2cm | liver: AST or ALT ≥ 1,000 | |
| Laboratory: increase in HCT concurrent with rapid decrease in platelet count | CNS: impaired consciousness failure of heart and other organs |
