© 2003 by BMJ Publishing Group & European League Against Rheumatism
LESSON OF THE MONTH
Suppurative polyarthritis following a rat bite
Series editor: Anthony D Woolf
Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
Correspondence to:
Correspondence to:
Dr B Yu-Hor Thong, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433;
bernard_thong@ttsh.com.sg
Accepted 11 March 2003
Keywords: polyarthritis; rat bite
| The first 150 words of the full text of this article appear below. |
A 62 year old healthy Chinese man was admitted to hospital three weeks after a rat bit his left foot. Four days after the bite he developed pain over his left foot followed by pain and swelling in both knees, elbows, wrists, the small joints of both hands, and the left ankle. He had no fever or constitutional symptoms.
On admission he was febrile and jaundiced. His blood pressure was 110/70 mm Hg. No cardiac murmurs were heard. There was no right hypochondrial tenderness or hepatomegaly. There was synovitis affecting his wrists, interphalangeal and metacarpophalangeal joints of the hands, effusions in his right knee, right ankle, and left midtarsal joint (fig 1
).
[in a new window] Figure 1 Synovitis of the right ankle and left midtarsal joint with the site of the rat bite (circled), which has healed.
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His haemoglobin was 125 g/l, white cell count 29.3x109/l with 90% polymorphs, platelet count
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