Journal of Investigative Medicine High Impact Case Reports (Jun 2013)

When Is “Pseudo–Ludwig’s Angina” Associated With Coagulopathy Also a “Pseudo” Hemorrhage?

  • Emily Lovallo MD,
  • Sarah Patterson MD,
  • Mitchel Erickson RN, MS, ACNP,
  • Cynthia Chin MD,
  • Paul Blanc MD,
  • Timur S. Durrani MD, MPH, MBA

DOI
https://doi.org/10.1177/2324709613492503
Journal volume & issue
Vol. 1

Abstract

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Sublingual hematoma secondary to short-acting anticoagulants such as warfarin has been labeled “pseudo–Ludwig’s angina” to distinguish it from the classic syndrome of localized infection and swelling involving the upper airway. Sublingual hematoma with airway compromise secondary to brodifacoum, a common long-acting anticoagulant rodenticide, has only been reported in the veterinary literature. We report a case of massive tongue swelling and impending airway compromise in the context of an intentional long-acting anticoagulant ingestion leading to coagulopathy. The swelling was initially presumed to be due either to infection or hemorrhage, but this was not supported by computed tomography scan imaging. Instead, the patient’s clinical course was consistent with corticosteroid-responsive angioedema, temporally associated with the ingested brodifacoum.