scholarly journals Chorea as the presenting feature of acute rheumatic fever in childhood; case reports from a low-prevalence European setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marta Illán Ramos ◽  
Belén Sagastizabal Cardelús ◽  
Adrián García Ron ◽  
Sara Guillén Martín ◽  
Arantxa Berzosa Sánchez ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Case Reports ◽  
Significant Proportion ◽  
Secondary Prophylaxis ◽  
The Body ◽  
Neurological Involvement ◽  
Initial Manifestation ◽  
The Past ◽  
Sydenham Chorea

Abstract Background Despite a notable decrease in acute rheumatic fever (ARF) incidence in the past few decades, there are still cases in our setting. Sydenham chorea (SC) may be the initial manifestation for this condition in childhood in a significant proportion of children. We report two cases of choreoathetosis in children as the first manifestation of ARF. Case presentation A previously healthy 8-year-old boy presented with right hemichorea with a predominance in the brachial region, orofacial dyskinesias and speech difficulties for the past 2 weeks. The only medical history of interest was a common catarrhal illness 3 weeks before and nonspecific bilateral tenosynovitis in both feet since a year prior. A brain computerized tomography was normal and the echocardiogram showed mild mitral and aortic regurgitation, meeting ARF criteria. He demonstrated clinical improvement with treatment based on prednisone and carbamazepine. The second patient was a 10-year-old girl with choreic movements of the right half of the body and repetitive right eye closure of 1 week duration. She had symptoms of fever and rash the previous week and pharyngitis that resolved without antibiotic 2 months before. Blood tests revealed elevated C reactive protein (12 mg/dl) and erythrocyte sedimentation rate (96 mm/h). Brain magnetic resonance was normal and echocardiogram showed left ventricle dilation and mild mitral regurgitation, leading to the diagnosis of ARF. Due to neurological involvement, she received corticosteroids and intravenous immunoglobulin treatment, with worsening of neurological symptoms that required valproic acid with remission of the hemichorea. In addition skin lessions compatible with erythema marginatum appeared on the upper limbs. Conclusions SC should be the main diagnostic consideration in cases of hemichorea with normal neuroimaging in children. The cases reported highlight the need to maintain a high index of suspicion even in settings where incidende of ARF is low and the need to perform cardiological investigations in all patients with suspected SC, due to the possibility of subclinical valve lesions. Good adherence to secondary prophylaxis is crucial to avoid chorea relapses and worsening valve disease.

Are all recurrences of “pure” Sydenham chorea true recurrences of acute rheumatic fever?

1985 ◽  
Vol 107 (6) ◽  
pp. 867-872 ◽  
Author(s):  
X. Berrios ◽  
F. Quesney ◽  
A. Morales ◽  
J. Blazquez ◽  
A.L. Bisno
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Sydenham Chorea

scholarly journals Clinic factors associated with better delivery of secondary prophylaxis in acute rheumatic fever management

2019 ◽  
Vol 48 (12) ◽  
pp. 859-865
Author(s):  
Emma Quinn ◽  
Seham Girgis ◽  
Joseph Van Buskirk ◽  
Veronica Matthews ◽  
Jeanette E Ward
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Secondary Prophylaxis ◽  
Factors Associated ◽  
Fever Management

scholarly journals Erythema marginatum: an uncommon presentation of acute rheumatic fever in a Nigerian adolescent girl—a case report

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Barakat Adeola Animasahun ◽  
Faith O. Lawani ◽  
Moriam Omolola Lamina
Keyword(s):  
Case Report ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Skin Lesions ◽  
Secondary Prophylaxis ◽  
Pulmonary Artery Hypertension ◽  
Mitral Valves ◽  
Reticular Pattern ◽  
Uncommon Presentation ◽  
The Face

Abstract Background Erythema marginatum is an uncommon presentation in children with acute rheumatic fever and it is one of the major criteria needed to make a diagnosis. It is seen in less than 10% of cases. It is also reported to be difficult to detect in black-skinned children. This is the first and only patient to present with the above since the inception of the unit about 14 years ago and also the first to be reported in Nigeria as far as the authors are aware, after a careful literature search; hence, we report this case based on the rarity of this symptom of acute rheumatic fever. Case presentation This is a case report of O.E, a 12-year-old Nigerian girl who presented with features of acute rheumatic fever, and these features included the rare manifestation of erythema marginatum. She presented with generalized skin eruptions on the trunk and extremities, sparing the face, migratory polyarthritis, features of congestive heart failure and high grade continuous fever. The skin lesions consisted of papules, patches, plaques and polycycles with a reticular pattern having serpiginous and raised borders. Diagnostic investigations revealed elevated erythrocyte sedimentation rate of 83mm/h, anti-streptolysin O titer of 2020IU/L and echocardiography which showed thickened mitral valves with grade II mitral regurgitation and a mild pulmonary artery hypertension. The patient was treated with anti-inflammatory and anti-failure drugs and commenced secondary prophylaxis with benzathine penicillin. Skin eruptions resolved within 3 weeks of management and are currently on follow up. Conclusions We present the above to increase awareness on the possibility of acute rheumatic fever presenting with erythema marginatum in our region, to encourage early diagnosis of acute rheumatic fever to reduce morbidity and mortality from its sequel, rheumatic heart disease.

scholarly journals Acute Rheumatic Fever: A Disease of the Past?

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Robert L. Myette
Keyword(s):  
Case Report ◽  
Rheumatic Fever ◽  
Streptococcus Pyogenes ◽  
Acute Rheumatic Fever ◽  
Healthy Children ◽  
Marginalized Populations ◽  
Urban Hospital ◽  
Urban Centers ◽  
The Past ◽  
Delays In Diagnosis

Introduction. Acute rheumatic fever (ARF) is a manifestation of the nonsuppurative sequelae of Streptococcus pyogenes infection. Herein, two cases of ARF are presented to highlight that this disease is present in urban cities, can be diagnosed in otherwise healthy children, and that its diagnosis may be challenging, or marred with confounders, leading to delays in diagnosis. Case Report. Two unrelated children, age 7 and 9, presented to an urban hospital in Canada with unique manifestations of ARF. Diagnosis of ARF in the first patient was interrupted by a course of steroids which masked symptoms leading to therapeutic delays. The second patient presented with facial droop and symptoms thought to be viral, thus leading to misdiagnosis as Bell’s palsy. Discussion/Conclusion. ARF is more common in underserviced and marginalized populations, which may lead clinicians in urban centers to overlook signs or symptoms suggestive of ARF because they no longer see this condition routinely, or they believe it is a disease of the past.

Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽  
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

Childhood acute rheumatic fever in Greece: Experience of the past 18 years

2001 ◽  
Vol 90 (7) ◽  
pp. 809-812 ◽  
Author(s):  
A Giannoulia-Karantana ◽  
G Anagnostopoulos ◽  
S Kostaridou ◽  
T Georgakopoulou ◽  
A Papadopoulou ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
The Past

Long-term observations of rheumatic carditis

1992 ◽  
Vol 2 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Kalim-ud-Din Aziz ◽  
L. Cheema ◽  
A.D. Memon
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Recurrent Infection ◽  
Secondary Prophylaxis ◽  
First Episode ◽  
Initial Attack ◽  
Rheumatic Carditis ◽  
Rheumatic Heart

AbstractA total of 246 consecutive patients were seen with the diagnosis of acute rheumatic fever (and/or rheumatic heart disease) and were followed for 587.7 patient years. The episode of acute rheumatic fever was the first in 64 of these patients, whereas recurrent acute rheumatic fever was seen in 26 and the other 156 patients had chronic rheumatic carditis. At presentation, those suffering an initial attack had less frequent and less severe carditis when compared to those suffering recurrent infection (p<0.05). Improvement in carditis during follow-up was noted in those having an initial attack (p<0.1), while deterioration occurred following recurrent infection (p<0.01), and no change was noted for those with chronic infection. Recurrences of acute rheumatic fever were most frequent in those presenting with their initial infection (21%) or reinfection (35%), and dropout from follow-up was highest in the group with first infection (38%) compared to those with recurrent infection (15%) and chronic carditis (25%). Non-recognition of the first episode of acute rheumatic fever and failure of secondary prophylaxis were found to be the major contributors to the observed increased pool of recurrent and chronic rheumatic heart disease. We conclude that, in the absence of programmed primary prophylaxis of acute rheumatic fever, the best chance of controlling the progression of carditis or affecting cure is to recognize the first episode ofacute rheumatic fever and then ensure strict adherence to secondary prophylaxis. Since the prognosis of recurrent carditis is poor, the best management of moderate to severe recurrent carditis is early reparative valvar surgery wherever possible.

Childhood acute rheumatic fever in Greece: Experience of the past 18 years

2007 ◽  
Vol 90 (7) ◽  
pp. 809-812
Author(s):  
A Giannoulia-Karantana ◽  
G Anagnostopoulos ◽  
S Kostaridou ◽  
T Georgakopoulou ◽  
A Papadopoulou
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
The Past
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