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[Fatal active rheumatic disease. Study of 13 necropsy cases]
L G Velloso1, A J Mansur, M Grinberg
1Instituto do Coração do Hospital das Clínicas, FMUSP, Div. Clínica, São Paulo.
Purpose:
To study the clinical features of a group of patients with fatal acute rheumatic fever (ARF).
Patients And Methods:
Thirteen patients with ARF, the ages ranged between 4.5 and 25 (mean 14) years. Eight patients were male. Patients were studied in two groups: group A of those 14 year-old or younger (8 cases), and group B of those older than 15 years (5 cases).
Results:
Clinical presentation was fever and severe heart failure in all patients. In group A, it was the first attack of ARF in 5 patients. The time elapsed between beginning of symptoms and hospital admission ranged between 10 and 90 (mean 40) days. Mitral insufficiency occurred in all patients. The blood leukocyte count was greater than 10000 per mm3 in six cases. Atrioventricular block occurred in one case. Valvular vegetations were detected on echocardiogram in 4 cases. Two patients received antibiotic therapy. Surgical treatment of the valvular heart disease was carried on in one patient. In group B, it was the first ARF attack in 2 cases, the time elapsed between beginning of the symptoms and hospital admission ranged between 4 and 60 (mean 21) days. Leukocyte count greater than 10000 por mm3 occurred in 4 cases. Atrioventricular block was diagnosed in one case. Valvular vegetations on echocardiogram were detected in 2 patients. In two cases, the treatment was antibiotic therapy. Three patients were operated on.
Conclusion:
ARF may still be fatal, even in the first attack or in patients in the third decade of life. Other diagnoses are frequently considered, due to the intense clinical and laboratorial manifestations.
Insights
Fatal acute rheumatic fever (ARF) can occur even in first-time attacks or in young adults. Intense clinical and laboratory signs can lead to misdiagnosis, highlighting the need for awareness of ARF
Area of Science:
- Cardiology
- Rheumatology
- Pediatric Cardiology
Context:
- Acute rheumatic fever (ARF) is an inflammatory disease that can follow streptococcal infection.
- While often treatable, severe cases can lead to significant morbidity and mortality.
- Understanding the clinical spectrum of fatal ARF is crucial for timely diagnosis and management.
Purpose:
- To investigate the clinical characteristics of patients who experienced fatal outcomes from acute rheumatic fever.
- To identify patterns and potential diagnostic challenges in severe ARF cases.
Summary:
- This study analyzed 13 patients with fatal ARF, aged 4.5 to 25 years, presenting with fever and severe heart failure.
- All patients exhibited mitral insufficiency; echocardiograms revealed valvular vegetations in some.
- Clinical and laboratory findings were intense, sometimes leading to consideration of alternative diagnoses.
Impact:
- Fatal ARF underscores the continued risk of this preventable disease, even in previously unaffected individuals.
- Highlights the importance of recognizing severe ARF presentations to prevent mortality.
- Emphasizes the need for heightened clinical suspicion for ARF, especially with severe cardiac involvement.