Once bitten, twice shy!

The incidence of infection after animal bites is increasing and can be a significant illness with many organs affected.1The key to successful management depends on an accurate diagnosis based on a careful history and isolation of the offending organism, followed by prompt institution of correct antibiotics and appropriate physiotherapy. To highlight this, we describe a patient who developed Pasteurella multocida cellulitis complicated by renal and liver disease, which led to a prolonged hospital stay. A 74 year old widower presented with a two week history of increasing pain and swelling of the right forearm and hand with diminished range of movement of the elbow. He had given shelter to a stray cat, which had bitten him on the dorsum of the right hand three weeks previously. He was pale and unwell with a temperature of 38.5°C. The right hand and forearm were grossly oedematous and inflamed with pustule formation (fig 1). There was also a tense olecranon bursitis which restricted movement of the right elbow. Healing puncture marks were visible over the dorsum of the right hand. He had been diagnosed with rheumatoid arthritis about 30 years ago and had been treated only with non-steroidal anti-inflammatory drugs. The rheumatoid disease was quiescent, and cardiovascular, respiratory, and abdominal systems were normal. Figure 1 Cellulitis of the right hand and forearm. Investigations showed a …