Ilgenfritz Seth, Dowlatshahi Cameron, Salkind Alan
Department of Emergency Medicine, Truman Medical Center, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
J Emerg Med. 2013 Oct;45(4):e103-6. doi: 10.1016/j.jemermed.2013.04.037. Epub 2013 Aug 2.
Acute rheumatic fever (ARF), a consequence of group A streptococcal (GAS) pharyngitis, is characterized by nonsuppurative inflammatory lesions of the joints as well as subcutaneous and cardiac tissues. Although the overall incidence of ARF in the United States has declined in recent years, there have been reports of outbreaks in closed populations, as well as sporadic cases. Traditionally considered a disease of children, adults may also acquire the disease. Because of declining incidence and a presentation that may overlap with other conditions, ARF may not be considered in the differential diagnosis. Failure to recognize ARF may result in delayed diagnosis and recurrent disease.
This report is designed to assist emergency physicians in identifying components of the history and physical examination that are important to making a timely diagnosis of ARF.
An otherwise healthy man presented to the emergency department (ED) with clinical findings consistent with ARF. Despite presentation to the ED on three occasions, during which he was treated for various conditions, it was not until the 3(rd) encounter that the diagnosis of ARF was considered.
Failure to recognize ARF may result in repeated ED visits, delayed diagnosis, and prolonged patient discomfort. Recognition of the condition is important to prevent recurrent disease.
急性风湿热（ARF）是A组链球菌（GAS）咽炎的后果，其特征为关节以及皮下和心脏组织的非化脓性炎性病变。尽管近年来美国ARF的总体发病率有所下降，但仍有关于封闭人群中暴发以及散发病例的报道。传统上认为ARF是一种儿童疾病，成人也可能罹患该病。由于发病率下降且其表现可能与其他病症重叠，在鉴别诊断中可能不会考虑ARF。未能识别ARF可能导致诊断延迟和疾病复发。
本报告旨在帮助急诊医生识别病史和体格检查中对及时诊断ARF重要的组成部分。
一名原本健康的男性因与ARF相符的临床表现就诊于急诊科（ED）。尽管他三次前往ED就诊，期间接受了针对各种病症的治疗，但直到第三次就诊才考虑到ARF的诊断。
未能识别ARF可能导致反复前往ED就诊、诊断延迟以及患者不适时间延长。识别该病症对于预防疾病复发很重要。
