Uncommon Diagnoses

1. Ludwig angina. Used to describe infection beginning at the floor of the mouth and rapidly spreading to involve bilateral sublingual and submandibular spaces without abscess formation or lymphatic involvement. Fever, drooling, neck stiffness, and swelling are typical.

Lemierre syndrome. Typically seen in adolescents and adults; refers to thrombophlebitis of the internal jugular vein, which is thought to occur as a result of oropharyngeal infection. Patients typically present with neck pain and swelling, fever, and rigors; infection is due to Fusobacterium necrophorum, bacteroides, and streptococcal and lactobacillus species. Kimura disease. Rare, inflammatory disorder, typically seen in Asian males and characterized by painless unilateral cervical adenopathy or subcutaneous head and neck masses, eosinophilia, and elevated immunoglobulin E (IgE) levels.

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