Ludwig's Angina and a Complicated Course of Streptococcus constellatus Management.

This article focuses on a complex case of Ludwig's angina, a rapidly progressing and potentially fatal cellulitis of the mouth floor and neck, caused by Streptococcus constellatus infection in a 22-year-old transgender woman with multiple comorbidities including pre-diabetes, Cushing syndrome, and alcohol use disorder. The infection originated from poor dentition and spread extensively to the mediastinum, pleura, mastoid, and central nervous system, necessitating prolonged intensive care with airway management, broad-spectrum antibiotics, multiple surgical drainage procedures, and tooth extractions. The case highlights the importance of early source control through Otolaryngology and Oromaxillofacial surgery interventions, as well as the challenges posed by antibiotic resistance and immunosuppression related to steroid hormone therapy and metabolic syndrome. It underscores the need for prompt imaging, such as early pan-CT scans, to detect abscess spread and guide treatment in severe infections caused by S. constellatus.