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Systemic vasculitis following an unreported rat bite
  1. R S Tattersall,
  2. J T Bourne
  1. Department of Rheumatology, Chesterfield and North Derbyshire Royal Hospital NHS Trust, UK
  1. Correspondence to:
    Dr R S Tattersall, Department of Rheumatology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK;

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A 56 year old man presented with a 10 day history of fevers, cough, sore throat, and loose stools. Two days after onset he developed an acute polyarthritis affecting the right wrist, left thumb, both feet, and the right ankle. This was followed by a rash over elbows, fingers, and feet. He had no rheumatological history, drank little alcohol and apart from antihypertensive treatment with atenolol and nifedipine, was fit and well.

On admission he was apyrexial with normal cardiorespiratory and abdominal examination. A maculopapular, non-blanching rash with pustules and necrosis was evident over the extensor surfaces of both elbows and left calf. In the web space of the index and middle finger of the right hand was a small crusted, healing lesion. Acute, erythematous synovitis affected his right elbow, wrist, and shoulder, left thumb metacarpophalangeal (MCP) joint, both mid-tarsal joints, and right ankle.

Laboratory investigations showed his haemoglobin was 112 g/l, white cell count 12.6×109/l, neutrophils 11.4×109/l, urea 17.7 mmol/l, and creatinine 169 μmol/l. The erythrocyte sedimentation rate was 79 …

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