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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 <jats:italic>S. constellatus<\/jats:italic> infections.<\/jats:p>","DOI":"10.1136\/bcr-2019-233971","type":"journal-article","created":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T15:24:32Z","timestamp":1585668272000},"page":"e233971","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Fulminating deep tissue space infection with <i>Streptococcus constellatus<\/i> presenting initially as a sore throat"],"prefix":"10.1136","volume":"13","author":[{"given":"Joe","family":"Glover","sequence":"first","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gorana","family":"Kovacevic","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Walton","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Parr","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,31]]},"reference":[{"key":"2025082707334701000_13.3.e233971.1","first-page":"832","article-title":"What are the most common conditions in primary care? systematic review","volume":"64","author":"Finley","year":"2018","journal-title":"Can Fam Physician"},{"key":"2025082707334701000_13.3.e233971.2","unstructured":"Wolford RW , Schaefer TJ . 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