An old disease re-emerging: acute rheumatic fever

Area of Science:

• Rheumatology
• Infectious Diseases
• Internal Medicine

Background:

• Acute rheumatic fever (ARF) is a serious inflammatory condition that can affect the heart, joints, brain, and skin.
• It typically follows a streptococcal infection, such as strep throat.
• Early recognition and management are crucial to prevent long-term complications.

Observation:

• A 41-year-old Australian woman presented with a 3-day history of fevers and migratory polyarthritis.
• Investigations revealed elevated inflammatory markers (CRP, ESR), leucocytosis, and a high antistreptolysin O (ASO) titre.
• Cardiac, neurological, and skin examinations were unremarkable.

Findings:

• The patient was diagnosed with acute rheumatic fever.
• Treatment included corticosteroids and a course of cephalexin.
• The patient achieved a full recovery with normalized inflammatory markers and liver function within 8 weeks.

Implications:

• This case underscores the importance of considering ARF in adults presenting with suggestive symptoms, even after antibiotic treatment for a preceding streptococcal infection.
• Timely diagnosis and appropriate management, including secondary prophylaxis with benzathine penicillin, are essential for preventing recurrent episodes and long-term sequelae.
• Raising awareness among healthcare providers about the varied presentations of ARF is vital for prompt patient care.