title: Rheumatic fever-mimicking carditis as a first presentation of chronic active Epstein-Barr virus infection.
abstract: A 7-y-old girl presented with prolonged fever, arrhythmia and cardiomegaly during the treatment course of group A beta-haemolytic streptococcal pharyngitis. The isolated rheumatogenic strain M1 suggested the diagnosis of rheumatic fever. However, serous pericardial effusion contained high levels of Epstein-Barr virus (EBV) DNA. Clonally proliferating EBV+ T cells were determined in the circulation. The atypical carditis without valvitis was then complicated by coronary artery dilatations. Four months after the start of prednisolone plus antiviral/bacterial therapy, EBV+ T-cell lymphoma developed in the thigh.
  
  
  CONCLUSIONS
  Atypical carditis may be a notable and life-threatening presentation of chronic active EBV infection to be differentiated from rheumatic fever.
authors.affiliation: Department of Paediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Taikai
authors.initials: T
authors.lastname: Toubo
authors.forename: Shouichi
authors.initials: S
authors.lastname: Ohga
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Takada
authors.forename: Naohiro
authors.initials: N
authors.lastname: Suga
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nomura
authors.forename: Takurou
authors.initials: T
authors.lastname: Ohno
authors.forename: Toshiro
authors.initials: T
authors.lastname: Hara
mesh_terms: D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005260:Female; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis / Q000382:microbiology* / Q000821:virology*; D012214:Rheumatic Heart Disease / Q000175:diagnosis*