This study reports the case of a previously healthy 9-year-old girl who presented with a middle cerebral artery (MCA) stroke secondary to Streptobacillus moniliformis infective endocarditis. She developed acute-onset dysarthria and right hemiplegia. An acute infarction of the MCA was diagnosed by MRI, and an 11 × 14 mm mitral valve vegetation was seen on an echocardiogram. As part of the initial history, it was discovered that the patient had several pet rats. A pathology specimen from the vegetation taken during valve replacement was culture positive for Streptobacillus moniliformis. S. moniliformis causes a rare and potentially fatal systemic illness in humans commonly known as rat-bite fever. This facultatively anaerobic, pleomorphic, gram-negative bacillus colonizes the oropharynx of rats and is spread to humans by rat bites and scratches, as well as the ingestion of rat feces in contaminated liquids. The slow growth of S. moniliformis often delays its diagnosis. The most common manifestations of the disease are arthralgia, fever, and rash. Only a few cases of S. moniliformis infection are reported per year, and less than 20 cases have been reported to be complicated by endocarditis. Our patient was treated with doxycycline followed by penicillin and completed a 6-week course of antibiotic therapy. Upon discharge from the hospital, her dysarthria and hemiplegia had nearly resolved. With the increased number of pet rats, the differential diagnosis of fever of unknown origin, rash, arthralgia, and endocarditis in pet rat owners should include S. moniliformis.
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