Alhadramy Osama
Department of Internal Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA.
J Taibah Univ Med Sci. 2020 Dec 17;16(1):121-126. doi: 10.1016/j.jtumed.2020.11.007. eCollection 2021 Feb.
Rheumatic fever (RF) is a complex syndrome in which the human body develops antibodies against β-haemolytic streptococcus, and triggers inflammation in various organs. RF valvulitis mostly affects the mitral valve (MV) and, to a lesser extent, the aortic valve (AV). Isolated rheumatic tricuspid valve (TV) disease and pericarditis is extremely rare and is not well described in the RF guidelines. The current case demonstrates the echocardiographic findings of TV valvulitis of RF and describes the presentation and electrocardiogram (ECG) changes in pericarditis. We present the case of a 16-year-old male patient who developed upper respiratory tract infection followed by typical pericarditis chest pain. The patient had no history of joint pain or swelling, but was found to have a tricuspid regurgitation (TR) murmur upon examination. Laboratory investigations revealed an elevated erythrocyte sedimentation rate, and elevated C-reactive protein and antistreptolysin O titres. ECG showed a wide-spread 1.5 mm upward concave ST-segment elevation. In echocardiography, the TV opened well with markedly thickened leaflets and severe TR, while the MV and AV were normal in both structure and function. The diagnosis of RF was established and treatment with high-dose aspirin and antibiotics was initiated. The treatment led to resolution of the chest pain. Our case highlights that the physical and lab findings of rheumatic TR are similar to those of rheumatic mitral regurgitation, with the exception of a high-velocity jet. Similarly, the presentations of rheumatic pericarditis are similar to other types and may also respond to high-dose aspirin. Finally, physicians should be familiar with both the common and rare complications of RF because the guidelines have placed Middle East region among the high-risk countries.
风湿热（RF）是一种复杂的综合征，人体会产生针对β溶血性链球菌的抗体，并引发各个器官的炎症。RF 瓣膜炎症大多影响二尖瓣（MV），其次是主动脉瓣（AV）。孤立性风湿性三尖瓣（TV）疾病和心包炎极为罕见，且在 RF 指南中描述不多。本病例展示了 RF 所致 TV 瓣膜炎的超声心动图表现，并描述了心包炎的临床表现和心电图（ECG）变化。我们报告一例 16 岁男性患者，该患者先出现上呼吸道感染，随后出现典型的心包炎胸痛。患者无关节疼痛或肿胀病史，但检查时发现有三尖瓣反流（TR）杂音。实验室检查显示红细胞沉降率升高、C 反应蛋白升高以及抗链球菌溶血素 O 滴度升高。心电图显示广泛的 1.5 毫米向上凹的 ST 段抬高。超声心动图检查发现，TV 开放良好，但瓣叶明显增厚且有严重 TR，而 MV 和 AV 的结构和功能均正常。确诊为 RF 后，开始使用大剂量阿司匹林和抗生素治疗。治疗后胸痛症状缓解。我们的病例强调，风湿性 TR 的体格检查和实验室检查结果与风湿性二尖瓣反流相似，只是射流速度较高。同样，风湿性心包炎的表现与其他类型相似，对大剂量阿司匹林治疗也可能有反应。最后，医生应熟悉 RF 的常见和罕见并发症，因为指南已将中东地区列为高风险地区。
