Acute Rheumatic Fever in Caucasians: A Case Report and Systematic Review

Acute Rheumatic Fever (ARF) is more common in children in the developing world. The current incidence in the United Kingdom is reported to be less than 1 in 100,000 children. It is, however, rare in the developed world, particularly in the adult Caucasian population. We present a case of ARF in a 39-year-old Caucasian female who needed multiple hospital admissions before the ARF diagnosis was made. A comprehensive, up-to-date literature review of ARF in Caucasians is lacking. Therefore, a systematic literature review (SLR) of Medline, PubMed, and Google Scholar was conducted to investigate the characteristics, management, and prognostic outcomes of new cases of ARF among Caucasians. A total of 10 cases were reported from six countries between 1990 and 2022. The mean age of patients was 33.2 (range 18-41), and most were females (6, 60%). The most common presenting symptoms were fever, arthralgia, and malaise. All patients met the modified Jones criteria for ARF diagnosis. All patients received antibiotics, with only one patient requiring corticosteroids. Two patients developed rheumatic heart disease (RHD), and none died as a result of ARF. This case-based literature review underscores the critical importance of a high index of clinical suspicion in promptly diagnosing ARF to mitigate long-term sequelae of RHD.