Ludwig's angina following herpetic gingivostomatitis in a toddler with tetralogy of Fallot

Ludwig's angina is a rare but potentially lethal cellulitis of the submandibular space that occurs most often in young adults with predisposing odontogenic infection. In contrast to adult cases, most children with Ludwig's angina have no initiating factor. We report a case of Ludwig's angina in a 15-month-old boy which developed after an episode of herpetic gingivostomatitis. Under close monitoring of respiratory status, the condition was successfully managed with antibiotic treatment. This case illustrates that Ludwig's angina can develop in association with herpetic gingivosmatitis, which is a common and usually self-limited disease in pediatric patients. Prompt recognition and aggressive management of this rare and severe secondary bacterial infection are the keys to avoiding unnecessary morbidity and mortality.