Acute Rheumatic Fever in an Adult Female Patient Presenting With Chest Pain: A Case Report

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Acute rheumatic fever (ARF) is an autoimmune condition following group A Streptococcus (GAS) infection, primarily affecting children in low-resource settings.
• While less common in developed nations, ARF and its complication, rheumatic heart disease (RHD), remain significant global health concerns.
• The disease mechanism involves molecular mimicry, where the immune response to GAS cross-reacts with host tissues.

Observation:

• A 39-year-old female presented with symptoms suggestive of ARF, including fever, sore throat, joint pain, and chest pain.
• Diagnostic criteria (Jones criteria) and laboratory tests, including elevated inflammatory markers and troponin-I, supported the ARF diagnosis with suspected carditis.
• Initial treatment involved antibiotics and anti-inflammatory medications, with an echocardiogram ruling out significant valvular disease.

Findings:

• The patient was diagnosed with ARF based on clinical presentation and diagnostic criteria.
• Treatment included azithromycin, naproxen, and dexamethasone, followed by long-term antibiotic prophylaxis.
• This case highlights the occurrence of ARF in adults, albeit rare in the US, emphasizing the need for vigilance.

Implications:

• Prompt diagnosis and management of ARF are crucial for preventing long-term sequelae, particularly RHD.
• Long-term antibiotic prophylaxis is essential for preventing recurrent ARF episodes.
• Continued research and enhanced healthcare strategies are necessary to mitigate the global impact of ARF and RHD.