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[Acute rheumatic fever (ARF) in an adult male]

Monica Maria Novoa Usme1, Angelika Bublak2, Iskandar Atmowihardjo2

  • 1Klinik für Kardiologie, DRK Kliniken Berlin Köpenick, Salvador-Allende-Str. 2-8, 12559, Berlin, Deutschland. m.novoa@drk-kliniken-berlin.de.

Innere Medizin (Heidelberg, Germany)
|August 4, 2022
PubMed

Insights

Acute rheumatic fever (ARF), rare in adults, can follow Streptococcus pyogenes tonsillitis. This case highlights ARF in a 29-year-old male, emphasizing prompt diagnosis and symptom management.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Acute rheumatic fever (ARF) is an autoimmune sequela of Streptococcus pyogenes infection, uncommon in Germany and rare in adults.
  • Treatment guidelines for ARF in adult populations remain controversial.
  • Streptococcus pyogenes remains a significant pathogen in pharyngitis and related complications.

Observation:

  • A 29-year-old male presented with ARF following tonsillitis treated with outpatient antibiotics (penicillin and amoxicillin/clavulanic acid).
  • Symptoms included fever, characteristic skin lesions, and polyarthritis, meeting the Jones criteria for ARF.
  • Initial management involved nonsteroidal anti-inflammatory drugs, leading to rapid symptom improvement.

Findings:

  • Elevated inflammatory markers and antistreptolysin O titers confirmed the diagnosis.
  • The patient received no antibiotic prophylaxis post-diagnosis.
  • Echocardiographic monitoring over 12 months revealed no cardiac involvement.

Implications:

  • This case underscores the importance of considering ARF in adults presenting with compatible symptoms after streptococcal pharyngitis.
  • Prompt diagnosis and symptomatic treatment with NSAIDs can be effective in managing ARF in adults.
  • Long-term echocardiographic surveillance is crucial for detecting subclinical carditis in adult ARF cases.
Keywords:
Acute rheumatic arthritisPolyarthritisRheumatic heart diseaseStreptococcus pyogenesTonsillitis

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