  Gram-negative rod bacteremia.  The patient was admitted to the hospital with suspicion of endocarditis given the fact that she had fever, septicemia, and Osler nodes on her fingers.  The patient had a transthoracic echocardiogram as an outpatient, which was equivocal, but a transesophageal echocardiogram here in the hospital was normal with no evidence of vegetations.  The microbiology laboratory stated that the Gram-negative rod appeared to be anaerobic, thus raising the possibility of organisms like bacteroides.  The patient does have a history of congenital genitourinary abnormalities which were surgically corrected before the fifth grade.  We did a CT scan of the abdomen and pelvis, which only showed some benign appearing cysts in the liver.  There was nothing remarkable as far as her kidneys, ureters, or bladder were concerned.  I spoke with Dr. XYZ of infectious diseases, and Dr. XYZ asked me to talk to the patient about any contact with animals, given the fact that we have had a recent outbreak of tularemia here in Utah.  Much to my surprise, the patient told me that she had multiple pet rats at home, which she was constantly in contact with.  I ordered tularemia and leptospirosis serologies on the advice of Dr. XYZ