Rat bite fever: a misnomer?

We report a case of rat bite fever (Streptobacillus moniliformis) in a young man who presented generally unwell with pyrexia, vomiting, arthralgia and deranged liver function. Two weeks before his illness he had disposed of a dead rat but was not bitten by it. This zoonotic infection was treated with broad spectrum antibiotics and he made a complete recovery. It is a rarely diagnosed but likely common infection given the frequent contact between humans and rodents. In the past, confirmation of the organism has been difficult due its dislike of culture mediums, but the advent of polymerase chain reaction (PCR) testing has allowed reliable isolation. Appropriate treatment is important because there is an associated mortality from secondary endocarditis.