https://clinicalproblemsolving.com/wp-content/uploads/2017/05/AVI-Jack-and-Reza-MR-pre-aup-1.mp3

Dr. Avital O’Glasser presents a clinical unknown on Virtual Morning Report to CPSolvers, Jack and Reza.

Case overview and teaching points

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Dr. Avital O’Glasser

Avital O’Glasser is an Associate Professor of Medicine at Oregon Health & Science University (OHSU) in the Division of Hospital Medicine. She is the medical director of OHSU’s hospitalist-led Pre-Operative Medicine Clinic, as well as The Curbsiders Kashlek Memorial Hospital Chief of Perioperative Medicine. She is also the Assistant Program Director for Social Media and Scholarship for OHSU’s Internal Medicine Residency Program. She has been a member of the OHSU faculty since completing her internal medicine residency training there, and she is a graduate of Jefferson Medical College. She enjoys spending time with her husband, two young boys, and labradoodle Matilda.

Case Summary

A 31-year-old man with no prior medical problems presented with subacute abdominal pain, recurrent fevers, and weight loss. His work-up was notable for stigmata of endocarditis, although bacterial blood cultures were persistently negative. Ultimately, he underwent aortic valve replacement, and pathologic examination of the valve tissue demonstrated coliform bacteria with molecular testing confirming a diagnosis of Streptobacillus moniliformis. Further history confirmed that he owned a pet rat and had experienced repeated bites prior to his illness. 

Teaching Points

• Streptobacillus moniliformisis a pleomorphic, gram-negative rod that is the predominant cause ofrat bite fever (RBF). This pathogen is found across the United States and is most commonly transmitted by rat bites, with numerous cases being acquired from pets or laboratory animals. Clinical manifestations include fever (potentially relapsing), arthralgias, and rash. Serious complications include infective endocarditis, meningitis, systemic vasculitis, and other organ involvement.