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An 18-year-old male college student presented to the local emergency department (ED) in septic shock, requiring ICU admission. Five days prior, he had symptoms of a sore throat and was evaluated at a health clinic where he tested negative for COVID-19, Group A Strep and infectious mononucleosis. Several days later, his symptoms worsened with body aches, fatigue, fever and chills, and 4 days of loose stool. He was referred to the ED by his primary care physician. 

In the ED, the patient was found to be febrile and hypotensive with right cervical lymphadenopathy on physical exam. Blood and urine cultures were collected. The patient's COVID-19, respiratory pathogen and gastrointestinal pathogen panels were all negative. A chest X-ray was performed, which showed a right lower lobe opacity- concerning for pneumonia. A head and neck CT was also performed and revealed multiple pulmonary masses consistent with septic emboli and a tiny non-occlusive thrombosis in the right jugular vein.

Following 29 hours of incubation, the anaerobic blood culture flagged positive and pleomorphic gram-negative bacilli were seen on the Gram stain. A multiplex blood culture identification panel was performed, but no targets were detected. After overnight subculture in an anaerobic atmosphere, small colonies grew that were susceptible to polymixin B and kanamycin, but resistant to vancomycin anaerobic special potency disks, and were spot indole positive. 

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