Ludwig Angina at 28 Weeks’ Gestation in Somalia with Persistent Deep Neck Collections Requiring Repeat Surgical Drainage: A Case Report

Ismail Mohamed Abdulle,1 Rayan Abdirahman Hassan21Department of Intensive Care Medicine, Dr. Sumait Hospital, SIMAD University, Mogadishu, Somalia; 2Department of Surgery, Dr. Sumait Hospital, SIMAD University, Mogadishu, SomaliaCorrespondence: Ismail Mohamed Abdulle, Department of Intensive Care Medicine, Dr. Sumait Hospital, SIMAD University, Hodan District, Mogadishu, Somalia, Tel +252 61 584 4297, Email [email protected]: Ludwig angina is a rapidly progressive odontogenic infection involving the floor of the mouth and submandibular spaces that can cause airway obstruction and sepsis. Pregnancy adds maternal airway vulnerability and the need for simultaneous fetal surveillance. The objective of this single-patient case report from Mogadishu, Somalia, is to describe persistent deep neck collections after initial drainage and highlight how repeat clinical assessment, inflammatory markers, imaging, and additional source control informed management.Case Presentation: A 28-year-old woman at 28 weeks’ gestation presented with progressive bilateral submandibular and anterior neck swelling, dysphagia, odynophagia, trismus, difficulty handling oral secretions, and tongue elevation after a mandibular molar infection and dental extraction. Contrast-enhanced computed tomography demonstrated bilateral submandibular, sublingual, and submental infection with multiloculated deep neck collections. The admission white blood cell count was 22.38 × 109/L, the absolute neutrophil count was 20.97 × 109/L, and C-reactive protein was 225 mg/L. After blood cultures were obtained, intravenous piperacillin–tazobactam and clindamycin were initiated, followed by urgent incision and drainage. Blood cultures yielded Staphylococcus aureus. Renewed swelling on hospital day 3 prompted repeat imaging, which showed persistent collections extending toward the thoracic inlet. A second surgical exploration and drainage achieved additional source control. By approximately day 10, the white blood cell count had decreased to 7.10 × 109/L and C-reactive protein to 50.4 mg/L. Maternal symptoms improved, and fetal assessments remained reassuring during hospitalization.Conclusion: Early clinical improvement after drainage does not confirm complete source control. Recurrent swelling or persistently abnormal inflammatory findings should prompt repeat imaging and timely consideration of additional drainage. In this patient, resolution of cervicofacial swelling and tongue protrusion, improved swallowing and oral intake, falling white blood cell count and C-reactive protein, and reassuring fetal assessments supported clinical improvement. This approach may help avoid delay in definitive source control in pregnancy-associated deep neck infection.Keywords: Ludwig angina, pregnancy, odontogenic infection, deep neck abscess, Staphylococcus aureus, case report