Related condition: Ludwig angina
Early warning findings:
(1) sore throat and/or neck pain
(2) facial swelling with erythema of overlying skin
(3) pain out of proportion to clinical findings
(4) induration with subcutaneous tissue firm/hard to palpation
(5) toxic appearance
(6) rapidly rising white blood cell count and C-reactive protein (CRP)
(7) poor response or progression with conservative therapy
A patient who is immunocompromised or who has risk factors may progress very rapidly.
Advanced findings:
(1) excessive swelling about the head and neck
(2) purplish discoloration of skin
(3) skin blistering, crepitation and/or ulceration
(4) mottled or necrotic skin, especially if rapidly spreading
(5) shock
(6) reduced level of consciousness
(7) gas in soft tissues seen on CT scan AND not explained by subcutaneous emphysema following penetrating trauma
