THE CASE: You begin heparin and resume her warfarin, more for her history of DVT than for the management of suppurative thrombophlebitis
Over the course of her hospital stay, she spikes a fever (≥100°F) every 24 hours for the first 5 days, after which the peak temperatures slowly drop to normal. She reaches therapeutic levels on warfarin and the heparin is discontinued. At no point do any respiratory symptoms develop. Aerobic blood cultures show no growth; to your chagrin, you find out that anaerobic cultures were not obtained. After 8 days, the patient’s neck is no longer tender, the swelling has gone down, she’s adequately anticoagulated, has been afebrile for 48 hours, and is extremely eager to go home.
She is discharged with a prescription of amoxicillin/clavulanate 3 times daily for 4 weeks, as the literature suggests that most Fusobacterium are sensitive to this agent.11 She is instructed to return if any recurrent fevers, chest pain, or respiratory symptoms develop. At a routine follow-up appointment in a month, she remains asymptomatic.
