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

## TL;DR

Two rare cases show how Ludwig’s angina and agranulocytosis can co-occur, emphasizing the need for early diagnosis and careful monitoring in immunocompromised patients.

## Contribution

This case series highlights the rare coexistence of Ludwig’s angina and agranulocytosis and provides insights into their management.

## Key findings

- Two patients with agranulocytosis developed Ludwig’s angina without classical risk factors.
- Timely treatment with G-CSF and antibiotics led to rapid recovery of both infection and neutrophil counts.
- The cases emphasize the importance of hematologic monitoring in patients on antithyroid drugs.

## Abstract

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.