Suspected acute rheumatic fever in a young man in England

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.

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Valvular heart disease

10.1093/med/9780199643219.003.0003 ◽

2012 ◽

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Rheumatic Fever ◽

Aortic Regurgitation ◽

Valvular Heart Disease ◽

Mitral Valve Prolapse ◽

Mitral Stenosis ◽

Acute Rheumatic Fever

General considerations 144Acute rheumatic fever 146Mitral stenosis: clinical features 150Mitral stenosis: investigations 152Mitral stenosis guidelines 156Mitral regurgitation 158Mitral regurgitation guidelines 161Mitral valve prolapse 162Aortic stenosis 164Management of aortic stenosis 168Aortic regurgitation 170Aortic regurgitation guidelines ...

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Evaluation of subclinical valvar disease in patients with rheumatic fever

Cardiology in the Young ◽

10.1017/s1047951103001069 ◽

2003 ◽

Vol 13 (6) ◽

pp. 495-499 ◽

Cited By ~ 18

Author(s):

Suheyla Ozkutlu ◽

Olgu Hallioglu ◽

Canan Ayabakan

Keyword(s):

Mitral Regurgitation ◽

Rheumatic Fever ◽

Aortic Regurgitation ◽

Doppler Echocardiography ◽

Acute Rheumatic Fever ◽

Disease Treatment ◽

Permanent Disability ◽

Subclinical Disease ◽

Diagnostic Criterion ◽

Adequate Evidence

Carditis is the only manifestation of acute rheumatic fever that leads to permanent disability. Hence, its diagnosis is of paramount importance. Recently, it has been reported that Doppler echocardiography has disclosed subclinical valvar regurgitation in some patients with acute rheumatic fever manifested as isolated arthritis or pure chorea. The prognosis of such patients with acute rheumatic fever and subclinical valvitis is not clear. We aimed, therefore, prospectively to investigate the potential to diagnose patients with subclinical carditis. We examined 40 patients, aged from 7 to 16 years, with Doppler evidence of mitral and aortic regurgitation, but in the absence of any pathologic murmur. The major findings satisfying the Jones criterions were arthritis in 29 patients, chorea in 10 patients, and arthritis and erythema marginatum in one patient. Of the patients, 33 had mitral regurgitation, 6 patients had combined mitral and aortic regurgitation, and one patient had aortic regurgitation. The patients were followed over a mean period of 18.1 ± 13.9 months, the valvar regurgitation disappearing in 23 (57.5%). No significant differences were observed in the resolution of the valvitis between those treated with acetylsalicylic acid, steroids, or those receiving no treatment. It is noteworthy, nonetheless, that patients treated with steroids were the fastest to recover from valvitis (p < 0.05).Based on our study, we suggest that subclinical valvitis demonstrated by echocardiography should now be accepted as adequate evidence for the diagnosis of carditis, and become a major diagnostic criterion for acute rheumatic fever. When managing this group of patients with subclinical disease, treatment with steroids seems to have a role in promoting early resolution of the valvitis.

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The mechanism of mitral regurgitation in carditis of acute rheumatic fever (ARF)

American Heart Journal ◽

10.1016/0002-8703(73)90538-3 ◽

1973 ◽

Vol 85 (1) ◽

pp. 139-140 ◽

Cited By ~ 4

Author(s):

Vicken V. Kalbian

Keyword(s):

Mitral Regurgitation ◽

Rheumatic Fever ◽

Acute Rheumatic Fever

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A case of acute rheumatic fever: Echocardiographic findings for mitral regurgitation in acute rheumatic carditis.

Japanese Circulation Journal ◽

10.1253/jcj.51.1393 ◽

1987 ◽

Vol 51 (12) ◽

pp. 1393-1396 ◽

Cited By ~ 4

Author(s):

YASUHISA KAJINO ◽

HAJIME IWAYANI ◽

NORIYUKI HANEDA ◽

MASAKAZU SAITO ◽

TOSHIKAZU NISHIO ◽

...

Keyword(s):

Mitral Regurgitation ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Rheumatic Carditis ◽

Echocardiographic Findings

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THERAPEUTIC EFFECTS OF ACTH AND CORTISONE IN RHEUMATIC FEVER: CARDIOLOGIC OBSERVATIONS IN A CONTROLLED SERIES OF 100 CASES

PEDIATRICS ◽

10.1542/peds.17.1.11 ◽

1956 ◽

Vol 17 (1) ◽

pp. 11-28

Author(s):

T. N. Harris ◽

Sidney Friedman ◽

Herbert L. Needleman ◽

Herbert A. Saltzman

Keyword(s):

Rheumatic Fever ◽

Hormone Therapy ◽

Acute Rheumatic Fever ◽

Supportive Therapy ◽

Therapeutic Effects ◽

Control Subjects ◽

Significant Difference ◽

And Control

The therapeutic effects of ACTH and cortisone have been studied in a series of 100 patients with acute rheumatic fever, with special emphasis on cardiologic observations. This series involved cyclical alternation among hormone-treated patients and control patients. The latter received symptomatic and supportive therapy, but not salicylates in large doses. Observations on such patients during the period of hospitalization (did not indicate any significant difference between hormone-treated and control subjects in terms of the appearance or disappearance of cardiac murmurs, the degree of transmission of apical systolic murmurs, incidence and duration of pericarditis, or other cardiologic phenomena recorded. Rates of occurrence of "rebound" phenomena and of complications of the hormone therapy have also been reported.

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Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽

10.1542/peds.70.3.506 ◽

1982 ◽

Vol 70 (3) ◽

pp. 506-507

Author(s):

Bernard Boxerbaum

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Secondary Prophylaxis ◽

Benzathine Penicillin ◽

Childrens Hospital ◽

Rheumatic Heart

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

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Can subclinical valvitis detected by echocardiography be accepted as evidence of carditis in the diagnosis of acute rheumatic fever?

Cardiology in the Young ◽

10.1017/s1047951101000269 ◽

2001 ◽

Vol 11 (3) ◽

pp. 255-260 ◽

Cited By ~ 29

Author(s):

Süheyla Özkutlu ◽

Canan Ayabakan ◽

Muhsin Saraçlar

Keyword(s):

Mitral Regurgitation ◽

Acetylsalicylic Acid ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Clinical Evidence ◽

Clinical Signs ◽

Mitral Insufficiency ◽

The One ◽

Echocardiographic Findings

Aim: Subclinical valvar insufficiency, or valvitis, has recently been identified using Doppler echocardiography in cases of acute rheumatic fever with isolated arthritis or chorea. The prognosis of such patients with acute rheumatic fever and subclinical valvitis is critical when determining the duration of antibiotic prophylaxis. We aimed, therefore, prospectively to investigate the association of silent valvitis in patients having rheumatic fever in the absence of clinical evidence of cardiac involvement, and to evaluate its prognosis. Methods and Results: Between November 1998 and September 1999, we identified 26 consecutive patients with silent valvitis in presence of rheumatic fever but in the absence of clinical signs of carditis. The patients, eight female and 18 male, were aged from 6 to 16 years, with a mean of 9.9± 2.7 years. Major findings were arthritis in 16, chorea in 7, and arthritis and erythema marginatum in 1 patient. Two cases had arthralgia with equivocal arthritic signs and Doppler echocardiographic findings of pathologic mitral regurgitation. Silent pathologic mitral regurgitation was found in 12 cases, and aortic regurgitation in 2 cases. All patients with arthritic findings were treated with acetylsalicylic acid with one exception, this patient receiving both prednisone and acetylsalicylic acid. No antiinflammatory treatment was given to patients with chorea. After a mean follow-up of 4.52 months, valvar regurgitation disappeared in 4 patients, including the one with migratory arthralgia and no other major criterions. All six patients with chorea and silent carditis still have mitral insufficiency. Conclusion: Acute rheumatic fever without clinical carditis is not a benign entity. Doppler echocardiographic findings of subclinical valvar insufficiency, therefore, should be considered as carditis when seeking to establish the diagnosis of acute rheumatic fever.

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Fulminant mitral regurgitation due to ruptured chordae tendinae in acute rheumatic fever

Journal of Paediatrics and Child Health ◽

10.1111/j.1440-1754.2007.01214.x ◽

2008 ◽

Vol 44 (3) ◽

pp. 134-137 ◽

Cited By ~ 22

Author(s):

Yvonne Anderson ◽

Nigel Wilson ◽

Ross Nicholson ◽

Kirsten Finucane

Keyword(s):

Mitral Regurgitation ◽

Rheumatic Fever ◽

Acute Rheumatic Fever

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Getting to the Heart of the Matter: A 20-Year-Old Man With Fever, Rash, and Chest Pain

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx272 ◽

2017 ◽

Vol 5 (1) ◽

Author(s):

Michelle C Sabo ◽

Jim Boonyaratanakornkit ◽

Robert Cybulski ◽

Noam E Kopmar ◽

Rosario V Freeman ◽

...

Keyword(s):

Chest Pain ◽

Rheumatic Fever ◽

Cardiac Tamponade ◽

Acute Rheumatic Fever ◽

Wide Spectrum ◽

Clinical Manifestations ◽

Helicobacter Cinaedi

Abstract Infection with Helicobacter cinaedi can encompass a wide spectrum of clinical manifestations, including fever, rash, endocarditis, osteomyelitis, and meningitis. The present case demonstrates the ability of H cinaedi to masquerade as acute rheumatic fever and represents the first reported case of cardiac tamponade caused by H cinaedi.

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