BMJ Case Reports 2015; doi:10.1136/bcr-2015-212240

Oh rats! Fever, rash and arthritis in a young woman

  1. Xavi Sanchez-Flores3
  1. 1Department of Family Medicine, University of Virginia, Charlottesville, Virginia, USA
  2. 2Department of Family Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
  3. 3Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Carina M Brown, cmb8bv{at}
  • Accepted 6 December 2015
  • Published 23 December 2015


A 17-year-old girl presented with worsening right-sided hip and low back pain for 2 days. She had also experienced intermittent fevers and a recurring maculopapular rash over the past 2 weeks. Social history revealed the presence of three domestic rats living in the girl's home. Blood cultures returned positive for Streptobacillus moniliformis, the causative agent of rat-bite fever. Rat-bite fever often goes undiagnosed, as the clinical presentation is non-specific. Untreated, the infection can result in death due to sepsis or endocarditis. The bacterium is generally susceptible to penicillin antibiotics with full clinical recovery when treated in a timely and appropriate manner. After 4 weeks of intravenous antibiotics, our patient fully recovered without long-term sequelae.

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