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Acute rheumatic fever associated with tenosynovitis and a unique cytokine profile

Hiroyuki Wakiguchi1, Fumiko Okazaki1, Yasuo Suzuki1

  • 1a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan.

Immunological Medicine
|April 3, 2019
PubMed

Insights

Magnetic resonance imaging (MRI) revealed tenosynovitis in a child with acute rheumatic fever (ARF). This finding aids in diagnosing ARF and differentiating it from systemic juvenile idiopathic arthritis (sJIA).

Area of Science:

  • Rheumatology
  • Pediatrics
  • Radiology

Background:

  • Acute rheumatic fever (ARF) is an inflammatory condition following group A Streptococcus infection, affecting multiple organs.
  • Limited reports exist on magnetic resonance imaging (MRI) findings in pediatric ARF cases.
  • Differentiating ARF from other inflammatory conditions like systemic juvenile idiopathic arthritis (sJIA) can be challenging.

Purpose of the Study:

  • To report the MRI findings in a pediatric patient diagnosed with ARF.
  • To explore the utility of MRI in diagnosing ARF, particularly in cases of fever of unknown origin.
  • To assess the role of serum interleukin-18 levels in the differential diagnosis between ARF and sJIA.

Main Methods:

  • Case presentation of an 8-year-old boy with prolonged fever and hand swelling.
  • Diagnostic procedures included MRI of the affected hand and serological testing for group A β-hemolytic Streptococcus.
  • Serum interleukin-18 levels were measured and compared to typical sJIA values.

Main Results:

  • MRI revealed tenosynovitis in the patient's hand.
  • The patient was diagnosed with ARF based on clinical presentation, serological tests, and subsequent development of migratory arthritis and erythema marginatum.
  • Serum interleukin-18 levels were lower than those typically observed in sJIA.

Conclusions:

  • MRI findings of tenosynovitis can be a valuable diagnostic clue for ARF, similar to its utility in sJIA, especially in unexplained fever.
  • Specific serological tests are crucial for confirming the ARF diagnosis.
  • Serum interleukin-18 levels may assist in distinguishing ARF from sJIA.
Keywords:
Fever of unknown origininterleukin-18magnetic resonance imagingnaproxensystemic juvenile idiopathic arthritis

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