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Migratory Polyarthralgias and Skin Rash: Rat Bite Fever with a Positive Anti-Cyclic Citrullinated Peptide

Ilya Y Shadrin1, Hasan Ahmad Hasan Albitar1, Ana Catarina Paim2

  • 1Department of Internal Medicine, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings. Innovations, Quality & Outcomes
|April 14, 2020
PubMed

Insights

Rat bite fever, a rare bacterial infection, can mimic rheumatologic conditions. This case highlights the importance of considering rat bite fever in patients with joint pain and rash, especially when anti-CCP antibodies are present.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Microbiology

Background:

  • Rat bite fever (RBF) is a rare bacterial infection caused by Streptobacillus moniliformis.
  • It is often underdiagnosed in the US and can be mistaken for viral or rheumatologic illnesses.
  • Untreated RBF carries a significant mortality risk.

Observation:

  • A patient presented with low back pain, progressing to a pustular rash and severe polyarthralgias.
  • The patient's presentation was initially suggestive of a rheumatologic condition.
  • Blood cultures confirmed Streptobacillus moniliformis infection.

Findings:

  • This is the first reported case of RBF associated with positive anti-cyclic citrullinated peptide (anti-CCP) antibodies.
  • The patient exhibited classic RBF symptoms including leukocytosis, elevated C-reactive protein, migratory polyarthralgias, and pustular rash.
  • Diagnosis was confirmed via positive blood cultures for S. moniliformis.

Implications:

  • The presence of anti-CCP antibodies in a patient with RBF symptoms may complicate diagnosis.
  • Early recognition and treatment of RBF are crucial to prevent severe outcomes.
  • This case expands the differential diagnosis for patients presenting with polyarthralgias and rash, particularly those with positive anti-CCP antibodies.
Keywords:
Anti-CCP, anti-cyclic citrullinated peptideCRP, C-reactive proteinRBF, rat bite feverSPS, sodium polyanethol sulfonateWBC, white blood cell

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