Cardiac failure following group A streptococcal infection with echocardiographically proven pericarditis, still insufficient arguments for acute rheumatic fever: a case report and literature update.
We recently encountered a 49-year-old female who developed fever due to group A streptococcal (GAS) bacteriaemia spreading to an abscess in the iliac muscle and a bacterial monarthritis of the right knee with a sterile arthritis of her left knee. Treatment was started with a six-week course of intravenous penicillin. She developed a mitral valve insufficiency and pericarditis on the tenth day of admission. In the third week heart failure developed with, on echocardiograph, a high output left ventricular failure without signs of valvulitis or myocarditis. Using a diuretic regimen she was recompensated. Because of the pericarditis with mitral valve insufficiency corticosteroids were given, which had a rapid beneficial effect. A discussion follows on the position of acute rheumatic fever versus post-streptococcal reactive arthritis in this clinical picture and the literature is updated.
Department of Rheumatology, Medical Centre Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands. TJansen@znb.nl
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Joosten
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Brouwer
D001170:Arthritis, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011241:Prednisone / Q000627:therapeutic use; D012213:Rheumatic Fever / Q000175:diagnosis; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
D005938:Glucocorticoids; D010406:Penicillins; D011241:Prednisone