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A 43-year-old man returns to the emergency department with complaints of fever, cough, right neck pain, and shortness of breath. He first went to his primary care physician 3 days previously with similar complaints and was diagnosed with exudative pharyngitis for which he was given azithromycin. Since then, however, his symptoms have grown progressively worse. He smokes a pack of cigarettes a day and is an occasional intravenous (IV) drug user. On examination he has a temperature of 39.4°C (103°F), pulse 100 beats per minute, blood pressure (BP) 100/60 mm Hg, SO2 92% on room air. There is persistent erythema in the posterior pharyngeal wall in addition to an area of erythema, swelling and tenderness along the course of right external jugular vein. Lung examination reveals decreased breath sounds at the right base. Chest x-ray (CXR) shows multiple cavitatory lesions and right pleural effusion. What organism is the most likely cause of this clinical presentation?

A. Epstein Barr virus (EBV)
B. Fusobacterium necrophorum
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pyogenes
 

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Agree with mosallam, it's Lemierre's disease, also known as postanginal sepsis and human necrobacillosis. May be it's important that lately Fusobacterium necrophorum spreading in US and Canada
 

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can you guys please elaborate the explanation...
want to know more about the Lemierre disease...:)
Yep the way I remember this, is that there are only 2 important gram (-) anerobic rods - Fusobacterium and Bacteroides. They both inhabit the GI tract: Fuso=mouth as a commensal and Bacteroides=butt or backside (the best way I can remember it is in the colon as a commensal-sorry).

They are both opportunistic, therefore Fusobacterium infects in times of immunosuppression, and bacteroides when there has been a perforation of the gut. (90% of gram (-) peritonitises are caused by this bacterium).
 
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