Abstract
Introduction: Rat-bite fever is an uncommon illness caused by Streptobacillus moniliformis or Spirillum minor. We present an unusual case of rat bite fever involving a left cemented total hip replacement after a rodent bite.
Case report: A 38-year-old lady, presented with poly arthralgia, who had Total Hip replacement for arthritis secondary to developmental dysplasia of Hip(one year ago), presented with signs & symptoms suggestive of infective joint pathology. Examination revealed painful restricted joint movements.
Initial blood tests revealed very high ESR, c-reactive proteins with leucocytosis. Blood cultures were negative. X-rays revealed dislocation of Total hip replacement Ultrasound scan and CT scan revealed a large collection of fluid in the Left Total Hip Replacement.
Aspirate from the affected joints revealed gram negative bacilli, Streptobacillus moniliformis. The joints were all washed out arthroscopically. She was put on intravenous antibiotics and continued for six weeks. The inflammatory markers normalised after six weeks. Follow up x-rays of the left hip prosthesis do reveal some signs of osteolysis and surveillance is ongoing.
Discussion: Prosthetic replacements are now commonplace, with large number of patients keeping pets. Septic arthritis following the rat bite has been reported. As far as we can tell from the available literature that it has not been reported in a joint prosthesis. The long- term outcome is unknown. The possibility of low grade infection involving the joint prosthesis and the association of this organism with endocarditis is a cause for concern.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
