Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits
While the incidence of acute rheumatic fever (ARF) in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the diseas...
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doaj-396d12be1f524a00810e493a1f8d16932020-11-24T23:31:17ZengHindawi LimitedCase Reports in Pediatrics2090-68032090-68112018-01-01201810.1155/2018/94671319467131Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department VisitsInna Kaminecki0Renuka Verma1Jacqueline Brunetto2Loyda I. Rivera3Department of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ, USADepartment of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ, USADepartment of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ, USADepartment of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ, USAWhile the incidence of acute rheumatic fever (ARF) in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the disease and clinical presentation that can mimic other conditions. We present the case of a 5-year-old boy with a history of intermittent fevers, fatigue, migratory joint pain, and weight loss following group A Streptococcus pharyngitis. The patient presented to the emergency department twice with the complaints described above. On his 3rd presentation, the workup for his symptoms revealed the diagnosis of acute rheumatic fever with severe mitral and aortic valve regurgitation. The patient was treated with penicillin G benzathine and was started on glucocorticoids for severe carditis. The patient was discharged with recommendations to continue secondary prophylaxis with penicillin G benzathine every 4 weeks for the next 10 years. This case illustrates importance of primary prevention of acute rheumatic fever with adequate antibiotic treatment of group A Streptococcus pharyngitis. Parents should also receive information and education that a child with a previous attack of ARF has higher risk for a recurrent attack of rheumatic fever. This can lead to development of severe rheumatic heart disease. Prevention of recurrent ARF requires continuous antimicrobial prophylaxis. Follow-up with a cardiologist every 1-2 years is essential to assess the heart for valve damage.http://dx.doi.org/10.1155/2018/9467131 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Inna Kaminecki Renuka Verma Jacqueline Brunetto Loyda I. Rivera |
spellingShingle |
Inna Kaminecki Renuka Verma Jacqueline Brunetto Loyda I. Rivera Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits Case Reports in Pediatrics |
author_facet |
Inna Kaminecki Renuka Verma Jacqueline Brunetto Loyda I. Rivera |
author_sort |
Inna Kaminecki |
title |
Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits |
title_short |
Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits |
title_full |
Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits |
title_fullStr |
Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits |
title_full_unstemmed |
Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits |
title_sort |
delayed diagnosis of acute rheumatic fever in a patient with multiple emergency department visits |
publisher |
Hindawi Limited |
series |
Case Reports in Pediatrics |
issn |
2090-6803 2090-6811 |
publishDate |
2018-01-01 |
description |
While the incidence of acute rheumatic fever (ARF) in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the disease and clinical presentation that can mimic other conditions. We present the case of a 5-year-old boy with a history of intermittent fevers, fatigue, migratory joint pain, and weight loss following group A Streptococcus pharyngitis. The patient presented to the emergency department twice with the complaints described above. On his 3rd presentation, the workup for his symptoms revealed the diagnosis of acute rheumatic fever with severe mitral and aortic valve regurgitation. The patient was treated with penicillin G benzathine and was started on glucocorticoids for severe carditis. The patient was discharged with recommendations to continue secondary prophylaxis with penicillin G benzathine every 4 weeks for the next 10 years. This case illustrates importance of primary prevention of acute rheumatic fever with adequate antibiotic treatment of group A Streptococcus pharyngitis. Parents should also receive information and education that a child with a previous attack of ARF has higher risk for a recurrent attack of rheumatic fever. This can lead to development of severe rheumatic heart disease. Prevention of recurrent ARF requires continuous antimicrobial prophylaxis. Follow-up with a cardiologist every 1-2 years is essential to assess the heart for valve damage. |
url |
http://dx.doi.org/10.1155/2018/9467131 |
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