Acute pancreatitis during treatment with amiodarone

A 37-year-old woman was in her bathroom and felt something brush against her bottom. When she turned on the lights, there was a bat hanging on the ceiling. The bat escaped through the open bathroom window. She looked at her skin and found nothing unusual, but she called her physician for reassurance. Her physician insisted that she be examined. Later that day, she saw her physician. No evidence of trauma was seen where the contact had occurred; however, her physician scrutinised the area with an otoscope (6 magnification), and found two pinpoint punctures approximately one-half centimeter apart. It was thought that these puncture marks could have been from the bat’s teeth but it was later considered more likely that they were from the bat’s claws. She was given post-exposure rabies prophylaxis and has remained well. The figure shows the mouth and right claw of a silver-haired bat. These bats weigh but a few ounces and their claws and teeth are very sharp. In 1995, a 4-year-old girl from the state of Washington, USA, and a 13-year-old girl from Connecticut, USA, died of rabies. In both cases, a bat was present in the children’s houses but no contact was recognised. Since 1980, there have been 28 cases of human rabies acquired in the United States, 15 were caused by rabies-virus strains associated with bats (ten were the virus strain typically isolated from the silver-haired bat). Most of these 15 patients never reported a bat bite or scratch. Because a bat scratch or bite may be very small and may not be felt, it is now recommended that “in situations in which a bat is physically present and the person(s) cannot reasonably exclude the possibility of a bite exposure, post-exposure prophylaxis should be given unless prompt capture and testing of the bat has excluded rabies virus infection”.