Rat bite fever is a systemic febrile illness caused by infection with the Gram-negative bacillus Streptobacillus moniliformis following a bite, scratch, or contact with excrement. Only 26 cases of native valve endocarditis have been reported to date. We could find no other reports of severe Streptobacillus endocarditis requiring valve replacement in a young, pregnant patient. A pregnant patient sought care for right leg pain, fevers, left upper quadrant pain, generalized weakness, fatigue, and inability to bear weight on her right leg. She had a syncopal episode 9 months earlier, resulting in a mandibular fracture and internal fixation hardware. Her pregnancy was complicated by hyperemesis and weight loss. Her pets included a rescued wild bird, a cat, and four rats. Her parents rescued stray cats, and she recalled multiple cat bites and scratches since childhood. She denied injection drug use. Ultrasound indicated a right popliteal artery thrombus. Transesophageal echocardiogram revealed a 2 cm × 0.7 cm vegetation. Angiography demonstrated multiple splenic infarcts and bilateral renal infarcts. She underwent mitral valve repair. The mitral valve Gram stain demonstrated 2+ Gram-negative rods, rare Gram-positive rods, and moderate white blood cells. Propionibacterium spp. was isolated from the mitral valve tissue on Columbia agar incubated anaerobically. Anaerobic and aerobic cultures of the valve tissue on all other broths and agars remained negative at 14 days. Hematoxylin and eosin stains showed a fibro-inflammatory vegetation. Aggregates of rod-shaped bacteria were identified on Warthin Starry/Steiner stain. Bartonella titers were positive for B. henselae IgG 1:256, IgM < 1:20. Brown-Hopps Gram stain, AFB, and GMS stains for bacterial and fungal microorganisms were negative. Broad range bacterial PCR and sequencing of a segment of 16 s rRNA gene of the valve tissue matched to Streptobacillus sp. (genus level) and most closely related to Streptobacillus moniliformis. This case demonstrates diagnostic and therapeutic challenges associated with a relatively uncommon cause of endocarditis. The diagnosis of rat bite fever was delayed due to symptoms of a concomitant pregnancy. Other confounders included possible alternative sources or co-infections with another zoonosis from multiple pets, and an odontogenic source due to presence of exposed jaw hardware.

中文翻译：

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一名孕妇严重复发性念珠菌链霉菌性心内膜炎，并复习文献。

大鼠咬伤性发热是一种全身性发热性疾病，由咬伤，抓挠或接触排泄物后感染革兰氏阴性菌莫尼氏链球菌引起。迄今为止，仅报道了26例天然瓣膜性心内膜炎。我们没有发现其他有关年轻孕妇怀孕期间需要更换瓣膜链球菌严重心内膜炎的报道。一名怀孕的患者寻求右腿疼痛，发烧，左上腹疼痛，全身无力，疲倦以及无法承受右腿重量的护理。她在9个月前发生晕厥发作，导致下颌骨折和内固定硬件。她的怀孕伴随着呕吐和体重减轻。她的宠物包括一只获救的野鸟，一只猫和四只老鼠。她的父母救了流浪猫，她回忆起从小就被猫咬伤和抓伤的情景。她否认注射毒品。超声检查显示右pop动脉血栓。经食道超声心动图显示2厘米×0.7厘米的植物。血管造影显示多发性脾梗塞和双侧肾梗塞。她接受了二尖瓣修复。二尖瓣革兰氏染色显示有2+革兰氏阴性棒，罕见的革兰氏阳性棒和中度白细胞。丙酸杆菌属。从厌氧培养的哥伦比亚琼脂上的二尖瓣组织中分离出分离出来的。在第14天，所有其他肉汤和琼脂上的瓣膜组织的厌氧和需氧培养保持阴性。苏木精和曙红染色显示纤维炎性植物。在Warthin Starry / Steiner染色剂上鉴定出棒状细菌的聚集体。巴尔通体滴度对亨氏芽孢杆菌IgG 1：256，IgM <1:20呈阳性。细菌和真菌微生物的Brown-Hopps革兰氏染色，AFB和GMS染色均为阴性。大范围细菌PCR和与链球菌sp。匹配的瓣膜组织的16s rRNA基因片段的测序。（属水平），并且与链霉菌链霉菌最密切相关。该病例表明与心内膜炎相对罕见的原因相关的诊断和治疗挑战。由于伴随妊娠的症状，导致大鼠咬伤性发热的诊断被推迟。其他混杂因素包括可能的替代来源或与多只宠物的另一种人畜共患病的共同感染，以及由于存在暴露的颌骨硬件而引起的牙源性来源。细菌和真菌微生物的GMS染色均为阴性。大范围细菌PCR和与链球菌sp。匹配的瓣膜组织的16s rRNA基因片段的测序。（属水平），并且与链霉菌链霉菌最密切相关。该病例表明与心内膜炎相对罕见的原因相关的诊断和治疗挑战。由于伴随妊娠的症状，导致大鼠咬伤性发热的诊断被推迟。其他混杂因素包括可能的替代来源或与多只宠物的另一种人畜共患病的共同感染，以及由于存在暴露的颌骨硬件而引起的牙源性来源。细菌和真菌微生物的GMS染色均为阴性。大范围细菌PCR和与链球菌sp。匹配的瓣膜组织的16s rRNA基因片段的测序。（属水平），并且与链霉菌链霉菌最密切相关。该病例表明与心内膜炎相对罕见的原因相关的诊断和治疗挑战。由于伴随妊娠的症状，导致大鼠咬伤性发热的诊断被推迟。其他混杂因素包括可能的替代来源或与多只宠物的另一种人畜共患病的共同感染，以及由于存在暴露的颌骨硬件而引起的牙源性来源。（属水平），并且与链霉菌链霉菌最密切相关。该病例表明与心内膜炎相对罕见的原因相关的诊断和治疗挑战。由于伴随妊娠的症状，导致大鼠咬伤性发热的诊断被推迟。其他混杂因素包括可能的替代来源或与多只宠物的另一种人畜共患病的共同感染，以及由于存在暴露的颌骨硬件而引起的牙源性来源。（属水平），并且与链霉菌链霉菌最密切相关。该病例表明与心内膜炎相对罕见的原因相关的诊断和治疗挑战。由于伴随妊娠的症状，导致大鼠咬伤性发热的诊断被推迟。其他混杂因素包括可能的替代来源或与多只宠物的另一种人畜共患病的共同感染，以及由于存在暴露的颌骨硬件而引起的牙源性来源。