This is a 52 year old male patient with a medical history of controlled arterial hypertension and stage V chronic renal disease of 6 years of evolution on haemodialysis 3 times a week who started his illness when he presented with odontalgia of the lower incisors, dysphagia, odynophagia, increased volume in the painful submandibular region and local hyperthermia, for which reason the patient attended the Oral and Maxillofacial Surgery Unit of the Hospital General del Oeste "Dr. José Gregorio Hernández" (CBMH). José Gregorio Hernández" (CBMF-HGO); 24 hours later, given the patient's systemic clinical conditions and presenting leukocytosis of 27,800 U/mm3, with neutrophilia of 82.4% and creatinine at 7.5 mg/dl, it was decided to admit him.
Physical examination revealed icteric sclerae, a severe increase in volume with a predominance of the submental and bilateral submandibular region and a mouth opening limited to approximately 15 mm. Intraoral examination revealed partial maxillomandibular edentulism, generalised chronic periodontal disease with grade IV mobility of 3.1 and 4.1, presence of local irritants, halitosis, severe enlargement of the floor of the mouth and bilateral sublingual space with glossoptosis.

In conjunction with the Infectious Diseases and Internal Medicine departments, empirical treatment was started with crystalline sodium penicillin 4,000,000 IU every 6 hours intravenously and aztreonam 1 g intravenously on a daily basis.
A CT scan showed an isodense image in the parapharyngeal space compatible with an increase in volume, showing a decrease in the airway lumen in the cervical region and corroborating the diagnosis of Ludwig's angina.

After 10 days of treatment, the evolution was torpid. A re-evaluation by the infectious diseases department indicated 1 g intravenous vancomycin, which caused significant clinical improvement in the patient. After systemic stabilisation of the patient, an exodontia of 3.1 and 4.1 and surgical drainage of the sublingual, submandibular and submentonian spaces was performed through a bilateral submentonian and submandibular incision inferior to the mandibular basal, which allowed access, communication and the establishment of 3 passive drains with a Nellaton probe for 3 daily washes of saline solution for 3 weeks.
The patient's evolution after surgical drainage and antibiotic therapy replacement showed a decrease in volume increase and a stabilisation of the respiratory rate. The last recorded haematology revealed a white series of 8,600 U/mm3, at the expense of neutrophils (78%), haemoglobin of 9.5 g/dl, haematocrit of 32.7% and creatinine of 6.8 mg/dl. All these conditions led to medical discharge.