Concurrent Ludwig’s Angina and Agranulocytosis: A Two-Case Series Highlighting Diagnostic and Therapeutic Challenges

Ludwig's angina (LA) is a rapidly progressive deep neck space infection that can become life-threatening due to airway compromise. Agranulocytosis, defined as a severe depletion of neutrophils, typically predisposes patients to overwhelming infections; however, its coexistence with LA is rare and poorly characterized. Here, we present two cases of patients with no classical predisposing factors who developed LA in the setting of agranulocytosis, each highlighting distinct clinical challenges in diagnosis and therapeutic decision-making. Both patients responded well to the timely initiation of granulocyte colony-stimulating factor (G-CSF) and antimicrobial therapy, with complete resolution and neutrophil recovery by day 5-6. These cases reinforce the importance of routine hematologic monitoring in patients prescribed antithyroid drugs such as carbimazole and underscore the need for early clinical vigilance for deep neck infections in immunocompromised individuals.