Recurrent acute rheumatic fever: a case report

Abstract

Introduction. It is estimated that about 3% of people untreated for group A streptococcal infection will develop rheumatic fever. In most case, an appropriate treatment with antibiotics will prevent acute rheumatic fever. However, not all case of acute rheumatic fever showed an apparent clinical presentation. Furthermore, some symptomatic patients did not seek medical treatment. These caused rheumatic fever and rheumatic heart disease still prevalent, especially in the developing country. Proper management, according to the latest guideline should be prompted in those individuals to halt the progression of cardiac damage. This article describes one such case.Case Description. A 15-year-old boy with a chief complaint of breathlessness during activity and improved with rest and multiple joint pain. He had a history of recurrent upper respiratory infection, which was not treated with antibiotics. On physical examination, the blood pressure was 110/70 mmHg and heart rate 110 bpm. On cardiac examination, he had holosystolic, and mid-diastolic murmur heard best at the apex. Laboratories test found WBC 15.420/μL, ASTO 400 IU/ml and CRP 48 mg/dL. Chest x-ray showed cardiothoracic ratio of 59% and echocardiography showed left atrial enlargement and left ventricular hypertrophy (ejection fraction 66%), mild mitral stenosis (MVA 1,6 cm2, mean MVG 13 mmHg), and severe mitral regurgitation. The patient was then diagnosed with recurrent acute rheumatic fever and treated with erythromycin 500 mg q.i.d and aspirin 500 mg q.i.d.Conclusion. Adequate management of acute rheumatic fever during and after the acute episode aimed to reduce the recurrence, prevent cardiac deterioration and expected to improve quality of life.