788 - Quadruple Amputation secondary to Ludwig’s Angina: A case report.

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

CW

Christian Wirawan, DO

PM&R Resident PGY-2
Schwab Rehabilitation, University of Chicago
Chicago, Illinois, United States

Co-Author(s)

MG

Marika Greiff, MD

Attending Physician
Schwab Rehabilitation
Chicago, Illinois, United States

Case Diagnosis:

Quadruple Amputation Secondary to Ludwig’s Angina

Case Description:

A 42-year-old woman with a past medical history of fibromyalgia presented with neck pain and facial swelling, associated with severe trismus and odynophagia. Patient was diagnosed with Ludwig’s Angina that rapidly progressed to necrotizing fasciitis, requiring multiple urgent face and neck debridements, as well as, tracheostomy and gastrostomy tube placements. Hospital course was further complicated by septic shock, thrombocytopenia, right iliac deep venous thrombosis, and arterial thrombosis that led to peripheral necrosis in bilateral upper and lower extremities. Ultimately, the patient underwent right below-elbow amputation (BEA), left above-elbow amputation (AEA), and bilateral below-knee amputations (BKA). She was initiated in the rehabilitation process, and upon discharge from acute inpatient rehabilitation, had achieved some level of independence with bed mobility, transfers, motorized wheelchair mobility, and basic upper body activities of daily living.

Discussions:

Life-changing multiple limb amputations are potential complications of severe sepsis. Ludwig’s angina is a rare but typically severe polymicrobial infection in the floor of the mouth that can take an aggressive course leading to severe sepsis. However, reports of Ludwig’s angina resulting in quadruple amputations remain limited. In this case, the severity of the condition characterized by necrotizing fasciitis, septic shock, and a hypercoagulable state, led to arterial thrombosis with peripheral necrosis, and consequently, a quadruple amputation. Rehabilitation plays a vital role in allowing sepsis survivors with multiple limb amputations to regain some level of function and reintegrate back into society.

Conclusions:

The rapidly changing disease course of Ludwig’s angina can result in severe sepsis and a hypercoagulable state, that can lead to arterial thrombosis and peripheral necrosis, with life-changing consequences of a quadruple amputation. For sepsis survivors with multiple limb amputations, rehabilitation can result in favorable outcomes that help them reintegrate back into society.