title: A Case of Streptobacillus moniliformis Infection with Cutaneous Leukocytoclastic Vasculitis.
abstract: A 71-year-old man presented with a high fever, polyarthralgia, petechiae and palpable purpura accompanied by livedoid change on his legs and feet. Histopathological findings of the purpura revealed perivascular infiltration of neutrophils, mononuclear cells, and nuclear debris, and extravasation of red cells mainly in the upper dermis: all signs consistent with leukocytoclastic vasculitis. Small vessel thrombi, which are characteristic features of septic vasculopathy, were also observed. Direct immunofluorescence showed negative results. Blood culture revealed the growth of gram-negative bacilli. Subsequently, 16S rRNA sequencing of DNA confirmed the organism as Streptobacillus moniliformis, which is the causative pathogen of rat-bite fever. He had frequently encountered wild rats in his house although there was no evidence of rat bite on his body. Empiric therapy with intravenous administration of ceftriaxone in combination with azithromycin hydrate led to a prompt resolution of the symptoms. Precise history-taking related to contact with rats and detection of skin eruptions suggestive of leukocytoclastic vasculitis on the extremities, especially on the feet, can be clues to Streptobacillus moniliformis infection. Familiarity with its cutaneous features is important for early diagnosis; the evidence herein may also help in understanding its underlying pathogenesis.
authors: Department of Dermatology, Okayama City Hospital, Okayama 700-8557, Japan.kawayoshio@yahoo.co.jp.
authors: Yoshio
authors: Y
authors: Kawakami
authors: Takashi
authors: T
authors: Katayama
authors: Masayuki
authors: M
authors: Kishida
authors: Wakako
authors: W
authors: Oda
authors: Yasuro
authors: Y
authors: Inoue
mesh_terms: D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D011906:Rat-Bite Fever / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D013288:Streptobacillus / Q000302:isolation & purification*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C425944:cefcapene pivoxil hydrochloride; D064704:Levofloxacin