{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:40:02Z","timestamp":1756377602569,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,6,22]]},"abstract":"An 18-year-old woman presented to clinic with acute pharyngitis with 4\/4 Centor criteria. Rapid streptococcal antigen test was negative. The patient, who was allergic to penicillin, was prescribed azithromycin. Ultimately, after 5\u2009days and without any corticosteroids, she presented to the emergency department with 10\/10 chest pain and was admitted to the intensive care unit. CT showed nodular lung disease and blood cultures on admission grew Fusobacterium,<\/jats:italic> likely \n Fusobacterium<\/jats:italic> nucleatum.<\/jats:italic> She sustained two cardiac arrests, three tube thoracostomies, acute kidney injury requiring dialysis and ventilatory failure requiring tracheostomy. After 16 days in hospital and 18 days in long-term acute care, the patient was discharged home. It is unclear how much of this could have been prevented by prescribing an antimicrobial that had activity against Fusobacterium<\/jats:italic>. When severe pharyngitis occurs, Fusobacterium<\/jats:italic> needs to be considered as an underlying cause. In vitro macrolides have marginal activity against most anaerobes, such as this pathogen, and should be avoided.<\/jats:p>","DOI":"10.1136\/bcr-2018-225149","type":"journal-article","created":{"date-parts":[[2018,7,20]],"date-time":"2018-07-20T03:06:14Z","timestamp":1532055974000},"page":"bcr-2018-225149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Lemierre\u2019s syndrome and 2016 American College of Physician guidelines for pharyngitis: no to empiric coverage for bacterial pharyngitis. While no role for routine Fusobacterium PCR, keep suspicion for this pathogen"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8078-8795","authenticated-orcid":false,"given":"Michael Saul","family":"Lundin","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Michigan State University, Sparrow Hospital, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subash","family":"Bastakoti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University, Sparrow Hospital, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Havlichek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University, Sparrow Hospital, East Lansing, Michigan, USA"},{"name":"Department of Infectious Disease, Michigan State University, Sparrow Hospital, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Laird-Fick","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University, Sparrow Hospital, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,19]]},"reference":[{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1305"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.3","doi-asserted-by":"publisher","DOI":"10.1080\/09674845.2005.11732687"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.4","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jinf.2014.03.005","article-title":"The significance and epidemiology of Fusobacterium necrophorum in sore throats","volume":"69","author":"Eaton","year":"2014","journal-title":"J Infect"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01719.x"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.6","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-008-0496-4"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/09674845.2007.11732757","article-title":"A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital","volume":"64","author":"Amess","year":"2007","journal-title":"Br J Biomed Sci"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.8","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1128\/AAC.37.10.2080","article-title":"Erythromycin, clarithromycin, and azithromycin: use of frequency distribution curves, scattergrams, and regression analyses to compare in vitro activities and describe cross-resistance","volume":"37","author":"Fass","year":"1993","journal-title":"Antimicrob Agents Chemother"},{"key":"2025082803164978000_2018.jul19_1.bcr-2018-225149.9","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-11-200912010-00011"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-225149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:16:57Z","timestamp":1756376217000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-225149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,19]]},"references-count":9,"alternative-id":["10.1136\/bcr-2018-225149"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-225149","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,7,19]]}}}