A case report of acute rheumatic fever and a brief review of the literature

Abstract

Acute rheumatic fever (ARF) is an inflammatory condition affecting different organs and organ systems. It can affect the heart, joints, central nervous system and subcutaneous tissues [1, 2]. It is believed to be a delayed sequela from an infection secondary to group A streptococ-cus (GAS). The first symptoms of the disease classically present two to three weeks after an infection with GAS. About 80% of affected patients present with carditis that can eventually lead to regurgitation [3]. A large proportion of patients also report painful joints. Chorea, erythema mar-ginatum and subcutaneous nodules are other less commonly reported symptoms. We present a case report of a patient with acute rheumatic fever followed by a brief discussion on the epidemiology, pathogenesis, diagnosis and treatment options for this condition. A 32-year-old woman presented to the Emergency Department with an initial complaint of pain and swelling in her lower extremities for 54 h, more severe in her left knee over the last 48 h. She denied any history of recent or past trauma to that region. She further added that she had previously experienced similar pain in her elbows and ankles. She did not seek any medical help at the time and her symptoms subsided with an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). On physical examination, the patient was afebrile with normal blood pressure, pulse rate and respiratory rate. The right lower extremity was normal with no edema, deformity or restricted range of motion. On the left side, she showed signs of tenderness in both the medial and lateral aspects of her left knee. She did not have any hepatosplenomegaly, and no other systemic abnormalities were found. She was prescribed painkillers and sent home. The patient presented again 10 days later with more severe pain in different joints, mostly her ankles, wrists and knees. She reported that the symptoms had not improved since her last visit and she was unable to come earlier because of her job. The physician in charge found blanching erythematous plaques over her body, most noticeably over the trunk and back. Subcutaneous nodules were also found on both arms. No murmurs were heard on auscultation and her neurologic examination was without any abnormalities. She was immediately admitted for further examination with a suspected diagnosis of acute rheumatic fever. A throat cul