Kaminecki Inna, Verma Renuka, Brunetto Jacqueline, Rivera Loyda I
Department of Pediatrics, The Unterberg Children's Hospital at Monmouth Medical Center, Long Branch, NJ, USA.
Case Rep Pediatr. 2018 Jun 4;2018:9467131. doi: 10.1155/2018/9467131. eCollection 2018.
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 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 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.
尽管过去几年美国急性风湿热（ARF）的发病率有所下降，但该疾病仍是儿童严重心血管疾病的病因之一。由于该疾病发病率降低以及临床表现可能与其他病症相似，医疗服务提供者对ARF的怀疑指数可能较低。我们报告一例5岁男孩病例，该男孩有咽炎病史，伴有间歇性发热、疲劳、游走性关节疼痛和体重减轻。患者因上述症状两次前往急诊科就诊。在他第三次就诊时，对其症状的检查显示诊断为急性风湿热，伴有严重的二尖瓣和主动脉瓣反流。患者接受了苄星青霉素G治疗，并开始使用糖皮质激素治疗严重心肌炎。患者出院时，建议在接下来的10年中每4周继续使用苄星青霉素G进行二级预防。该病例说明了通过对咽炎进行充分的抗生素治疗来一级预防急性风湿热的重要性。家长也应获得相关信息并接受教育，即既往有ARF发作史的儿童再次发作风湿热的风险更高。这可能导致严重风湿性心脏病的发展。预防ARF复发需要持续的抗菌预防。每1 - 2年由心脏病专家进行随访对于评估心脏瓣膜损伤至关重要。
