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Acute Rheumatic Fever or Post-streptococcal Reactive Arthritis: Two Different Entities

Ricardo Silva Veiga1, Marta Marques2, José Fonseca1

  • 1Internal Medicine, Hospital São Teotónio, Viseu, PRT.

Cureus
|December 2, 2024
PubMed

Insights

This case study highlights the diagnostic challenge between acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSReA) following group A streptococcal infections. Early recognition of ARF is crucial to prevent serious complications.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Group A Streptococcus (GAS) infections can lead to various post-infectious sequelae.
  • Distinguishing between acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSReA) can be challenging due to overlapping clinical presentations.

Observation:

  • A 71-year-old male presented with fever, polyarthralgia, and migratory arthritis one week after a diagnosed pharyngitis.
  • The patient had laboratory confirmation of a recent GAS infection with elevated antistreptolysin O (ASO) titers.
  • Clinical features presented ambiguity, exhibiting characteristics of both ARF and PSReA.

Findings:

  • The case illustrates the diagnostic uncertainty when a patient exhibits symptoms suggestive of both ARF and PSReA.
  • The shared etiology and overlapping clinical features suggest these conditions may exist on a disease spectrum.

Implications:

  • Emphasizes the importance of considering ARF in patients with suspected recent streptococcal infections presenting with polyarthralgia and fever.
  • Highlights the need for timely diagnosis and appropriate management of ARF to prevent long-term complications.
  • Suggests a potential continuum between ARF and PSReA, necessitating further research into their relationship.
Keywords:
adult onset acute rheumatic fevergroup a streptococcal infectionsjones criteriapost-streptococcal reactive arthritisreactive arthritis

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