title: A Case of Adult-Onset Acute Rheumatic Fever With Long-Lasting Atrioventricular Block Requiring Permanent Pacemaker Implantation.
abstract: A 45-year-old hypertensive Japanese woman presented with epigastric pain on inspiration, fever, complete atrioventricular block and polyarthritis. Her antistreptolysin O levels were markedly elevated. A diagnosis of rheumatic fever was made according to the modified Jones criteria. She was prescribed loxoprofen sodium, which was partially effective for her extracardiac clinical symptoms. However, she had syncope due to complete atrioventricular block with asystole longer than 10 seconds. Consequently, we implanted a permanent pacemaker. Although we prescribed prednisolone, the efficacy of which was limited for the patient's conduction disturbance, the complete atrioventricular block persisted. In our systematic review of 12 similar cases, the duration of complete heart block was always transient and there was no case requiring a permanent pacemaker. We thus encountered a very rare case of adult-onset acute rheumatic fever with persistent complete atrioventricular block necessitating permanent pacemaker implantation.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Oba
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Yoshioki
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Takao
authors.initials: T
authors.lastname: Nagashima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Imai
authors.forename: Masahisa
authors.initials: M
authors.lastname: Shimpo
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000989:Antistreptolysin / Q000097:blood; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010666:Phenylpropionates / Q000008:administration & dosage*; D011239:Prednisolone / Q000008:administration & dosage*; D012213:Rheumatic Fever / Q000097:blood / Q000150:complications / Q000175:diagnosis; D013575:Syncope / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D010666:Phenylpropionates; C040656:loxoprofen; D000989:Antistreptolysin; D011239:Prednisolone