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Case report
Fulminating deep tissue space infection with Streptococcus constellatus presenting initially as a sore throat
  1. Joe Glover,
  2. Gorana Kovacevic,
  3. Gary Walton and
  4. David Parr
  1. University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Professor David Parr; david.parr{at}uhcw.nhs.uk

Abstract

Management of sore throat requires robust decision-making to balance successfully the conflicting risks of unnecessary antibiotic use against those of untreated bacterial infection. We present a case of fulminant sepsis caused by Streptococcus constellatus, presenting as a sore throat, initially managed conservatively. Despite subsequent appropriate anti-microbial therapy and surgical drainage, contiguous spread ultimately involved the deep neck spaces, mediastinum and thoracic wall, and was complicated by severe aspiration pneumonia, pharyngocutaneous and bronchopleural fistulation. The complexity and widespread extent of the infected spaces, in conjunction with the catabolic response to sepsis, created a life-threatening situation. Surgical closure of the pharyngeal defect, using a pectoralis-major pedicle flap, was successfully undertaken to ensure source control of the infection and heralded a complete recovery. We describe our management of this case, discuss the current approach to the management of patients presenting with a sore throat, and review the literature on S. constellatus infections.

  • ear, nose and throat/otolaryngology
  • infectious diseases
  • respiratory medicine
  • general practice / family medicine
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Footnotes

  • Contributors JG: major contribution to design, planning, the acquisition and interpretation of data, drafting and critically revising the manuscript, approval of the final version and agreement to be accountable for all aspects of the work. Also involved in inpatient care. GK: substantial contribution to the design and interpretation of data, critically revising the manuscript, approval of the final version and agreement to be accountable for all aspects of the work. Also, major contribution to inpatient care. GW: substantial contribution to design, critically revising the manuscript, approval of the final version and agreement to be accountable for all aspects of the work. Also, major contribution to inpatient care. DP: major contribution to the design, planning, interpretation of data, drafting and critically revising the manuscript, approval of the final version and agreement to be accountable for all aspects of the work. Also, major contribution to inpatient care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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