A rare case of acute rheumatic fever with three different types of atrioventricular blocks in the same patient

Acute rheumatic fever (ARF) is a systemic autoimmune disease that results from abnormal immune response to group A streptococcus pharyngitis. Although first-degree atrioventricular (AV) block is the most common rhythm problem associated with the disease, other conduction abnormalities also could be seen. We reported three different types of conduction defects (first-degree AV block, second-degree AV block, and complete AV block) in a 15-year-old case diagnosed with ARF. A 15-year-old male patient presented with palpitation. Physical examination findings were unremarkable except dysrhythmic heart sounds. Acute phase reactants were positive, and electrocardiogram showed second-degree type I AV block at hospital admission. In the 2^nd day of admission, right first metatarsophalangeal arthritis as well as arthralgia involved both knees and ankles developed. Echocardiography revealed moderate rheumatic mitral regurgitation. First-degree AV block with brief complete AV block episode was seen on 24 h rhythm Holter recordings. Based on clinical and laboratory findings, ARF diagnosis was made and anti-inflammatory therapy (naproxen sodium) with benzathine penicillin G was started to the patient. First-degree AV block lasted 3 weeks and other conduction disorders were not seen again first, second, and complete AV block which could be seen during ARF episode and ARF should be considered as a one of the causes of arrhythmias.