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Occupational injury in a fishmonger with a macular rash, hepatosplenomegaly and pancytopenia

Department of Haematology, Addenbrooke’s Hospital, Cambridge, UK

Correspondence to:
L J Cooke
Department of Transfusion Medicine, National Blood Service, Long Road, Cambridge CB2 2PT, UK; lisajc{at}doctors.org.uk
ABSTRACT
A 47-year-old fishmonger presented with a history of weight loss and lethargy. On investigation he was found to have myeloma. He presented again before follow up, with a 3-day history of fever and a maculopapular rash. He was admitted to the haematology ward and treated with broad-spectrum antibiotics. Blood cultures were found to be positive for Erysipelothrix rhusiopathiae. Penicillin treatment was given, and he made a good recovery. The importance of occupational illness in an already immunocompromised patient and of taking a proper social and occupational history from patients on admission is illustrated through this case.