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Acquired brown syndrome in a child with acute rheumatic fever
Elishai Assayag1, Hashem Totah1, Elena Drabkin1
1Department of Ophthalmology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Purpose:
To describe a rare case of acquired Brown syndrome (ABS) associated with acute rheumatic fever (ARF).
Case Report:
a healthy 9-year-old girl developed polyarthritis, carditis, and elevated inflammatory markers 10 days after suffering from a sore throat. She was diagnosed with ARF and was treated with systemic antibiotics and high-dose non-steroidal anti-inflammatory drug (NSAID). After 2 weeks, despite improvement of ARF symptoms, the patient presented with binocular vertical diplopia, periorbital pain, and limited elevation in adduction of the left eye. Imaging revealed a thickened trochlea-superior oblique tendon complex, and ABS due to trochleitis was diagnosed. The patient underwent a successful regional corticosteroid injection as a second-line treatment, and within a month, all signs and symptoms of ABS resolved.
Conclusions:
ABS is an infrequent yet possible manifestation of ARF.
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