Rethinking dogma: an Asian case report of streptobacillary rat-bite fever

Rat-bite fever (RBF) is a rare but potentially fatal zoonotic disease that has resurfaced in literature from time to time. RBF has conventionally been attributed to Streptobacillus moniliformis in the Western World and Spirillum minus in Asia. However, numerous case reports of Streptobacillus moniliformis in Asia highlight the need to rethink this assertion. We encountered a patient with streptobacillary RBF and a history of recent travel to Bangladesh. We present the salient clinical features and processes in arriving at this diagnosis. The patient was successfully treated with no major sequelae, likely due to the early institution of appropriate antibiotics. We present our learning points on RBF including recognition, early and appropriate antibiotics and the challenges in diagnosing RBF.