Rat-bite fever caused by Streptobacillus moniliformis.

A 24 year old Thai male laborer from Bangkok, complained of fever, multiple joint pain and skin rash for 10 days. He was bitten on the right foot by a rat while he was entering a store room. Four days later, he developed diarrhea which was successfully self-treated with an antidiarrheal drug. The next day, he began to have high fever, malaise and headache which was temporarily relieved by dipyrone. A nonpruritic generalized erythematous rash accentuated on palms and soles was noted on the day after. Simultaneously, he developed pain over shoulder, knee, ankle and wrist joints. The patient was treated by a local hospital doctor without any improvement. Four days later, the patient came to Siriraj Hospital and was treated for drug allergy in the Outpatient Department. His symptoms of fever, malaise, joint pain and skin rash continued. He was admitted to the hospital 6 days later.