Introduction: Fever and rash is a common pediatric presentation to the emergency department but can present a diagnostic challenge to the clinician. Here we report the successful identification and treatment of a rare zoonotic exanthem that was facilitated by a thorough history and physical exam.

Case Report: Rat-bite fever is a potentially fatal systemic illness characterized by relapsing fever, rash, and migratory polyarthralgias. Treatment includes antibiotics for Streptobacillus moniliformis, the most common pathogen, as well as appropriate hygiene education and prevention strategies. We report a case of S. moniliformis in the absence of an actual rodent bite.

Conclusion: Due to the generally non-specific presentation of the illness, as well as the growing trend of caring for domestic rodents, it is crucial that clinicians ask details related to zoonotic and other exposures while obtaining medical histories.