Acute Rheumatic Fever in a Low Prevalence Setting

Acute rheumatic fever is a systemic inflammatory condition caused by beta-hemolytic streptococcal infection. Its prevalence in high-income countries has fallen significantly as a result of widespread antibiotic use and improved living conditions.

We report the case of an 18-year-old, otherwise healthy, Irish woman who presented to an Irish hospital with fever and general malaise on a background of recurrent pharyngitis. Her condition rapidly deteriorated in the hospital and she developed septic shock requiring intensive care admission for organ support. Investigations confirmed pancarditis secondary to acute rheumatic fever, which was ultimately treated with antibiotics and corticosteroids.

This case highlights that acute rheumatic fever can present with multiple nonspecific symptoms, in unexpected populations, including in the developed world. Early diagnosis and treatment initiation of antimicrobial therapy and corticosteroids is imperative for optimal overall outcomes in rheumatic heart disease.