PresentationTwo patients came into the Emergency Department of the same hospital complaining of fever and neck pain. One patient also had a sore throat whereas the other had hip pain. Three days prior to being seen in the Emergency Department, patient #1 was seen in Urgent Care complaining of a fever and sore throat and therefore tested for Group A Streptococcus. The test was negative and the patient was sent home with a clinical diagnosis of viral pharyngitis. Patient #2 was also seen 3- and 5-days prior in the Emergency Department complaining of fever and sore throat. No testing was performed and the patient was sent home with a clinical diagnosis of viral pharyngitis.
Lab TestingIn the Emergency Department, patient #1 had a chest X-ray performed and upon examination showed the presence of multiple lung nodules. The physician then suspected an infection and blood cultures were drawn. Patient #2 had a computed tomography (CT) scan performed of the hip and upon examination showed gas around the hip joint and thickening of the thigh muscle. The physician then suspected an infection and blood cultures were drawn. Anerobic blood culture bottle was positive for both patients and showed the presence of a pleomorphic gram-negative rod. Blood culture bottles were sub-cultured to anaerobic media (Brucella Blood Agar, Phenylethyl Alcohol Agar, Laked Blood Agar with Vancomycin and Kanamycin, and Bacteroides Bile Esculin Agar). After 48 hours of anaerobic incubation the cultures grew Fusobacterium necrophorum.
Cause of SymptomsF. necrophorum is part of the oral flora of the mouth but can also be an opportunistic pathogen associated with dental infection, sore throat and peri-tonsillar abscess. The most severe manifestation is internal jugular vein thrombosis leading to bacteremia and dissemination of septic emboli, otherwise known as Lemierre’s Syndrome. The disease is rare but patients often present with sore throat and neck pain which is typically misdiagnosed as viral pharyngitis or strep throat.
TreatmentBoth patients received antibiotics and recovered, though patient #2 required multiple debridements of her thigh.
Nicole Jackson, firstname.lastname@example.org