Barts Health NHS Foundation Trust, London, UK
Barts Health NHS Foundation Trust, London, UK.
Clin Med (Lond). 2018 Oct;18(5):400-402. doi: 10.7861/clinmedicine.18-5-400.
We present the case of a 41-year-old Australian woman with a 3-day history of fevers and migratory polyarthritis. Three weeks prior she had been treated by her GP with phenoxymethylpenicillin for acute tonsillitis. Examination confirmed synovitis. Systemic assessment including cardiovascular, neurological and skin examination was unremarkable. Abnormal investigations included a leucocytosis with neutrophilia, C-reactive peptide of 116 mg/L, erythrocyte sedimentation rate of 103 mm/hour and acute transaminitis. The antistreptolysin O titre was 304 IU, which increased to 1,250 IU after 2 weeks. Troponin T, electrocardiogram and echocardiography were all normal. The patient was treated for acute rheumatic fever with corticosteroids and a 10-day course of cephalexin. After 8 weeks, she made a full recovery and had normalised inflammatory markers and liver biochemistry. She was then commenced on monthly prophylactic intramuscular benzathine penicillin. This case study aims to raise awareness of the presentation, diagnosis and management of acute rheumatic fever.
我们报告了一例 41 岁的澳大利亚女性，她有 3 天的发热和游走性多关节炎病史。3 周前，她曾因急性扁桃体炎在全科医生处接受苯氧甲基青霉素治疗。检查证实存在滑膜炎。全身评估，包括心血管、神经和皮肤检查均无异常。异常检查包括白细胞增多伴中性粒细胞增多、C 反应蛋白 116mg/L、红细胞沉降率 103mm/h 和急性转氨基酶升高。抗链球菌溶血素 O 滴度为 304IU，2 周后增至 1250IU。肌钙蛋白 T、心电图和超声心动图均正常。该患者接受了皮质类固醇和 10 天头孢氨苄治疗急性风湿热。8 周后，她完全康复，炎症标志物和肝功能生化指标均恢复正常。然后开始每月肌内注射苄星青霉素预防。本病例研究旨在提高对急性风湿热的表现、诊断和管理的认识。
