Overlooking Recurrent Acute Rheumatic Fever in Adulthood

Area of Science:

• Rheumatology
• Infectious Diseases
• Genetics and Hereditary Diseases

Background:

• Acute rheumatic fever (ARF) is an inflammatory sequela of Group A Streptococcus infection, typically affecting children and adolescents.
• While ARF is uncommon in adults, recurrent episodes can occur, especially in populations with endemic streptococcal infections.
• Native Hawaiian and other Pacific Islander populations have a higher burden of rheumatic heart disease, underscoring the importance of understanding ARF in these groups.

Observation:

• A 29-year-old Native Hawaiian and other Pacific Islander presented with migratory polyarthralgia and fever.
• The patient had a history of childhood ARF and recent purulent lower extremity wounds (pyoderma).
• Diagnostic workup revealed elevated Antistreptolysin-O and Anti-DNase B titers, confirming recurrent ARF.

Findings:

• This case illustrates recurrent ARF in an adult of Native Hawaiian and other Pacific Islander ancestry, linked to pyoderma.
• Both childhood and adult ARF episodes experienced diagnostic and management delays.
• The patient responded well to naproxen and was initiated on secondary antibiotic prophylaxis.

Implications:

• Healthcare providers in the Pacific region must recognize the association between pyoderma and ARF in adults.
• ARF should be considered in the differential diagnosis of polyarthralgia in adult patients, especially in high-risk populations.
• Timely diagnosis and management of ARF are crucial to prevent long-term complications, including rheumatic heart disease.