Acute Rheumatic Fever Beyond Childhood: Case Series of Adult Recurrence and Atypical Manifestations

Acute rheumatic fever (ARF) is an autoimmune condition following a preceding beta-haemolytic streptococcal throat infection. It affects children in the age group of 5-15 years predominantly. In the older age group, the incidence decreases, with the first episode being very rare, though recurrence may occur. Further, patients who develop ARF in childhood, unless they quit the penicillin prophylaxis, recurrence or reactivation is also less.  This is a retrospective case series of six adult patients aged >30 years who presented to our hospital in the last one year and were diagnosed with either ARF or reactivation as per the 2015 revised Jones criteria. This study was conducted to emphasise that ARF is not an uncommon disease in adults in our country. Though the patient may have subtle symptoms and signs, we need to identify them and evaluate further with the required investigations to prove the diagnosis with the modified Jones criteria. When an adult patient presents with fever, joint pain, and valvular lesions, rheumatic fever is least thought of due to the age of the patient, and multiple other differentials are considered. Patients in our case series had varied presentations and acute rheumatic activity. To conclude, physicians should have a low threshold to consider ARF irrespective of age, and once ARF is diagnosed, patients need to be properly counselled about the strict adherence to penicillin prophylaxis.