Recurrent acute rheumatic fever: a forgotten diagnosis?
The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.
Kadir
Isaac S
IS
Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. ikadir@aol.com
Barker
Thomas A
TA
Clarke
Bernard
B
Denley
Helen
H
Grötte
Geir J
GJ
D000208:Acute Disease; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology; D018771:Arthralgia / Q000209:etiology; D001459:Bangladesh / Q000208:ethnology; D017291:Clarithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004641:Emigration and Immigration; D004697:Endocarditis, Bacterial / Q000175:diagnosis; D004739:England; D005260:Female; D005334:Fever / Q000209:etiology; D005839:Gentamicins / Q000627:therapeutic use; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D010400:Penicillin G / Q000627:therapeutic use; D010404:Penicillin V / Q000627:therapeutic use; D010493:Pericarditis / Q000473:pathology; D010612:Pharyngitis / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012213:Rheumatic Fever / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012214:Rheumatic Heart Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012293:Rifampin / Q000627:therapeutic use; D019564:Unnecessary Procedures; D014640:Vancomycin / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D005839:Gentamicins; D014640:Vancomycin; D000658:Amoxicillin; D017291:Clarithromycin; D010400:Penicillin G; D011241:Prednisone; D012293:Rifampin; D010404:Penicillin V