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Case Report
A hidden bite: Unveiling rat bite fever in a 17-month-old
1 Ross University School of Medicine, Two Mile Hill, St. Michael, BB11093, Barbados
2 Pediatric Intensive Care Unit, Sinai Hospital, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA
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Chinwendu N Ezeoru
Ross University School of Medicine, St. Michael,
Barbados
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Article ID: 100028Z19CE2025
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Ezeoru CN, Penfil S. A hidden bite: Unveiling rat bite fever in a 17-month-old. J Case Rep Images Pediatr 2025;7(2):1–4.ABSTRACT
Introduction: Rat bite fever is a zoonotic illness that is typically transmitted through rodent bites or consuming contaminated water or food, though some cases have also reported transmission by body fluids. Organisms involved can include Streptobacillus moniliformis, Streptobacillus notomytis, and Spirillum minus. The organism did not grow in hospital lab culture after three days and was sent to State Lab, was detected on day 7 by polymerase chain reaction (PCR).
Case Report: We report a case of a 17-month-old unimmunized male brought to the emergency department with change in behavior, fever, decreased oral intake, and hand and foot pain due to a suspected animal bite. His condition deteriorated over the course of admission from persistent low-grade fevers, dehydration and rash to include evidence of sepsis, and the development of acute kidney injury and respiratory distress. Although the initial gram stain of blood cultures was positive, the cultures revealed no growth.
Conclusion: Rat bite fever is rare and is often caused by difficult-to-detect Streptobacillus moniliformis. Blood cultures commonly yield negative results. It is imperative to prioritize complete exposure history in suspected cases, and empiric treatment with cephalosporin antibiotics should be started as soon as possible until definitive identification of the organism is achieved, as delays in treatment can result in serious complications.
Keywords: Pediatric, Rat bites, Rat bite fever, Sepsis, Streptobacillus moniliformis, Zoonoses
SUPPORTING INFORMATION
Author Contributions
Chinwendu N Ezeoru - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Scott Penfil - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Chinwendu N Ezeoru et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
