Pseudo-Ludwig's Angina: Spontaneous Sublingual Haematoma Elicited by Warfarin

Spontaneous bleeding into the upper airways is a rare and potentially life-threatening complication of chronic anticoagulation. There are scarce cases in the literature demonstrating upper airway haematomas secondary to warfarin use, which is the predominant anticoagulant used by clinicians despite having a complex pharmacokinetic and pharmacodynamic profile. We report a compelling case featuring warfarin-induced sublingual haematoma, managed conservatively through the reversal of anticoagulation using fresh frozen plasma complemented by vigilant monitoring within the Intensive Care Unit (ICU).

Learning points: Sublingual haematomas, though uncommon, represent potentially serious complications arising from warfarin therapy.Distinguishing sublingual haematomas from infectious processes requires a high level of clinical suspicion and is crucial for prompt management.The preferred course of action involves reversing anticoagulation with a low threshold for implementing an artificial airway in cases of compromised airways.