A 41-year-old immunocompetent female with a history of uterine cancer status post hysterectomy, migraines, and anxiety presented to the hospital with a one-month history of headache, myalgias, and subjective fevers. Blood work showed a leukocytosis (16.9) and elevated C-reactive protein (98.3). Other inflammatory markers including erythrocyte sedimentation rate, C3, and C4 were normal. Blood cultures (bcx) were drawn.

Physical exam noted neck hypertonicity along with tenderness along vertebral column and neck musculature. Initial computed tomography angiography (CTA) of the head and neck showed narrowing of the left internal carotid artery (ICA) at the junction of horizontal and vertical petrous segments and present to the mid cavernous ICA, which were concerning for dissection/intramural hematoma. MRI with and without contrast did not reveal any other acute pathology.

On Hospital Day 3, 1 of 2 bcx grew gram-negative and gram-positive rods. On Hospital Day 6 a repeat MRI showed mild dural thickening and enhancement involving the walls of the left cavernous sinus extending posteriorly along the tentorial leaf and the left cavernous ICA appeared small in size compared to the right ICA. On day 7 cultures speciated to Parvimonas micra 2 of 2 bcx and fusobacterium nucleatum 1 of 2 bcx.

Due to the presence of oral flora in bcx, additional history was gathered from the patient. The patient shared with staff a history of incomplete dental work. Oral exam revealed several partially extracted teeth with intact roots. This was felt to be the source of her infection and that her “dissection” was actually an infectious vasculitis. The patient underwent successful root extraction and was treated with 4 weeks of intravenous antibiotics. Interval CTA showed improvement in the left ICA narrowing.

Here we present to our knowledge the first case of carotid vasculitis secondary to Parvimonas micra and fusobacterium nucleatum.