Streptobacillus moniliformis endocarditis: case report and review.

A 46-year-old man with rat-bite fever due to Streptobacillus moniliformis that was complicated by endocarditis is reported. Other unusual features of this case include septic arthritis with prominent involvement of the sternoclavicular joint and the absence of a rash. Sixteen cases of streptobacillary endocarditis have previously been described. This condition occurs most often in the setting of previously damaged heart valves, usually as a result of rheumatic heart disease. Echocardiography demonstrated valvular vegetations in two of the four cases in which it was performed. Embolic phenomena are rare, and therapy with adequate doses of penicillin is usually curative.