Nonspecific presentations, such as fever and rash, commonly present to the emergency
department (ED). In such situations, a thorough history should be obtained, which
includes any pet or animal exposure. When history elicits a recent rat exposure in
combination with a patient presenting with fever and a rash, rat bite fever (RBF)
should be considered. A bacterial illness caused by Streptobacillus moniliformis, RBF has a high mortality, and treatment should begin promptly once suspected. As
its name suggests, RBF is most commonly caused by a rat bite, although any exposure
to a rat or other rodent should raise suspicion for the illness. Here, we present
an 8-year-old girl who came to the ED with complaints of fever, rash, and migratory
arthralgias. The initial history and laboratory studies were unrevealing. Upon further
questioning, the patient denied any bug or animal bites; however, she admitted to
recently acquiring a new pet rat, which she let lick her mouth and lips. Rat bite
fever was strongly suspected, and the patient was started on appropriate antibiotics
in the ED. She made a full recovery within 48 hours of hospital admission. Although
rare, RBF is a diagnosis that emergency physicians should be aware of because of its
high mortality but favorable response to treatment. In addition, its incidence is
increasing likely due to the increased popularity of rats as pets.
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Article Info
Publication History
Published online: November 20, 2015
Accepted:
November 17,
2015
Received:
November 5,
2015
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.