Acute Rheumatic Fever Without Pharyngitis: A Case Report

Area of Science:

• Rheumatology
• Cardiology
• Infectious Diseases

Background:

• Acute rheumatic fever (ARF) is an inflammatory condition following group A Streptococcus infection.
• ARF diagnosis can be challenging, especially in adolescents and young adults presenting with atypical symptoms.
• Delayed diagnosis and treatment of ARF can lead to severe cardiac complications, including rheumatic heart disease.

Purpose of the Study:

• To report a case of acute rheumatic fever in an 18-year-old man with atypical presentation.
• To highlight the diagnostic challenges and importance of adhering to diagnostic criteria for ARF.
• To emphasize the effectiveness of prompt treatment in managing ARF and its associated complications.

Main Methods:

• Case report of an 18-year-old male patient.
• Clinical evaluation including physical examination and laboratory tests (antistreptolysin O titer).
• Diagnostic criteria application (revised Jones criteria).
• Therapeutic intervention with amoxicillin and corticosteroids.

Main Results:

• The patient presented with fatigue and polyarthralgia unresponsive to NSAIDs.
• Cardiac involvement was noted, including a murmur and atrioventricular block.
• Elevated antistreptolysin O titer supported the diagnosis of ARF.
• Treatment led to rapid resolution of symptoms and electrocardiographic abnormalities.

Conclusions:

• Acute rheumatic fever should be considered in young adults with persistent polyarthralgia and systemic symptoms, even without preceding respiratory illness.
• The revised Jones criteria are essential for accurate ARF diagnosis.
• Prompt treatment with antibiotics and corticosteroids is effective in managing ARF and preventing long-term sequelae.