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Rat bite fever: an unusual cause of a maculopapular rash
  1. Andrew Rosser1,
  2. Martin Wiselka1,
  3. Manish Pareek2
  1. 1Department of Infection and Tropical Medicine, University Hospitals of Leicester, Leicester, UK
  2. 2Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
  1. Correspondence to Dr Manish Pareek, Department of Infection, Immunity and Inflammation, Maurice Shock Medical Sciences Building, University Road, Leicester, LE1 9HN; mp426@leicester.ac.uk

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Introduction

Rat bite fever (RBF) is a rare zoonosis caused worldwide by Streptobacillus monoliformis with Spirillum minus cases restricted to Asia.1 Transmission arises mainly by scratches or bites from colonised rats.1 At-risk groups include veterinarians, sewerage and laboratory workers or rat owners.1 Patients typically present within 7 days of exposure with an acute febrile illness characterised by headache, myalgia, migratory polyarthralgia and a rash.2 In the UK, one–two cases are diagnosed per year3 predominantly caused by S monoliformis.2 It is likely underdiagnosed due to a wide differential diagnosis and low culture sensitivity.2 If not suspected and treated with an appropriate antibiotic such as penicillin, mortality may reach 13%.1

Case history

A …

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