Gas Gangrene in the Neck Caused by an Odontogenic Infection
A 51-year-old male, known to be suffering from Type II diabetes mellitus (DM) and hypertension was admitted to the hospital with complaints of pain and swelling in the submandibular region for 3-4 days , together with a high grade fever. Patient had noticed a swelling in the left submandibular region 3- 4 days back with a painful 38. The swelling progressively increased crossing the midline and extending down the neck up to the upper mediastinum. Skin over the swelling was warm, erythematous, and pitting under pressure. The swelling was firm and tender with areas of crackling sensation. Intraorally the floor of the mouth was raised with areas of gangrenous necrosis on the left side medial to 38. The patient had difficulty in breathing and deglutition He was toxic with WBC counts on admission being 27,000, SPO2 was around 92% and temperature was 102 degrees F. Fasting blood sugar was 187mg/dl.Axial and sagittal sections of Computed tomographic scans showed air pockets in the bilateral submandibular and sublingual spaces which was descending along a subcutaneous plane in the neck upto the sternum suggestive of gas gangrene. InjAmikacin 1.5 g and InjMetrogyl 100ml. Culture revealed Ps. aeruginosa and K. pneumoniae. Blood culture revealed K. pneumoniae K. pneumoniae, while urine culture grew Pseudomonas and E. coli. No anerobes were seen to grow in any of the blood or urine cultures. The antibiotics were continued for three weeks.The swelling reduced and clinical signs subsided within 2 weeks. By: https://www.gavinpublishers.com/article/view/gas-gangrene-in-the-neck-caused-by-an-odontogenic-infection-a-case-report
