Given the high mortality rate without intervention, early diagnosis and treatment of AST remain paramount in order to prevent poor outcomes. There are limited recommendations in the current published literature for a streamlined diagnostic approach and management strategy to provide guidance to clinicians [2, 8, 9]. In this case report, we highlight a diagnostic approach and management of AST by use of targeted intravenous (IV) antibiotics followed by transition to oral antibiotics in an adult patient with a history of IV drug use and a preexisting goiter.