From a rat otorrhagia to a febrile rash

Abstract

A 19-year-old patient, without medical history, presented a first episode of continuous fever (about 39°C) for 14 days, with rash and arthromyalgia and functional impotence of the ankles for 7 days. Clinically, the patient had asthenia with ankle biarthritis with a predominantly palm-plant rash (Figure 1). Right ankle joint puncture finding inflammatory fluid (5300 nucleated elements/mm3 including 91% neutrophils), without microcrystals. Immunological test (rheumatoid factor and citrullinated anti-peptide antibodies) was negative. The skin biopsy performed in an area of pathological skin is in favor of an infectious origin, with microabscesses.