title: When Is "Pseudo-Ludwig's Angina" Associated With Coagulopathy Also a "Pseudo" Hemorrhage?
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Highland Hospital, Alameda County Medical Center, Oakland CA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Lovallo
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Patterson
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Erickson
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chin
authors.affiliation: University of California, San Francisco, CA, USA ; California Poison Control System, San Francisco Division, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Blanc
authors.affiliation: University of California, San Francisco, CA, USA ; California Poison Control System, San Francisco Division, CA, USA.
authors.forename: Timur S
authors.initials: TS
authors.lastname: Durrani
keywords: Ludwig’s angina; angioedema; brodifacoum; hemorrhage; sublingual hematoma; warfarin