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

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.