Nguyen Amanda, Cohen Garrett, Lam Matthew
Department of Medicine, University of California Davis Medical Center, Sacramento, USA.
Division of Cardiovascular Medicine, University of California Davis, Sacramento, USA.
J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251362985. doi: 10.1177/23247096251362985. Epub 2025 Jul 31.
Acute rheumatic fever (ARF) is a complication of streptococcal pharyngitis that can present with cardiac, joint, skin, and neurological symptoms. Cardiac manifestations most often involve valvular dysfunction, but can also include myocarditis or pericarditis. Although advances in healthcare have reduced the prevalence of streptococcal pharyngitis, and subsequently ARF, individual cases and outbreaks can still occur. We present a case of rheumatic myopericarditis in a 60-year-old White male who initially presented to the emergency department with sore throat for 6 days. Initial workup was largely unremarkable, and no microbiological testing was performed at that time. He was diagnosed with presumed viral pharyngitis and discharged home with supportive care. He returned 1 week later with pleuritic mid-sternal chest pain and dyspnea. Laboratory tests were significant for elevated inflammatory markers, cardiac enzyme markers, anti-streptolysin O titers, and bacteremia. Further evaluation revealed pericarditis, moderate pericardial effusion without tamponade, and reduced systolic function without valvular disease. The patient was diagnosed with rheumatic myopericarditis. Management included pericardial drainage, guideline-directed medical therapy for systolic heart failure and pericarditis, and primary treatment and secondary prevention of ARF with antibiotics. Currently, the patient's cardiac function has recovered, and he regularly follows up with his medical care team. Although less common in present times, clinicians are encouraged to consider streptococcal pharyngitis and ARF on the differential diagnosis for patients presenting with pharyngeal symptoms and subsequent cardiac manifestations, with or without valvular dysfunction. Primary and secondary prevention of ARF is paramount to maintaining the low incidence of this disease.
急性风湿热（ARF）是链球菌性咽炎的一种并发症，可表现为心脏、关节、皮肤和神经症状。心脏表现最常涉及瓣膜功能障碍，但也可包括心肌炎或心包炎。尽管医疗保健的进步降低了链球菌性咽炎的患病率，进而降低了ARF的患病率，但个别病例和疫情仍可能发生。我们报告一例60岁白人男性风湿性心肌心包炎病例，该患者最初因咽痛6天就诊于急诊科。初步检查结果大多无异常，当时未进行微生物检测。他被诊断为疑似病毒性咽炎，并在支持治疗后出院回家。1周后，他因胸骨中下段胸膜炎性胸痛和呼吸困难再次就诊。实验室检查显示炎症标志物、心脏酶标志物、抗链球菌溶血素O滴度升高以及菌血症。进一步评估发现心包炎、中度心包积液但无心脏压塞，收缩功能降低但无瓣膜疾病。该患者被诊断为风湿性心肌心包炎。治疗包括心包引流、针对收缩性心力衰竭和心包炎的指南指导药物治疗，以及使用抗生素对ARF进行初级治疗和二级预防。目前，患者的心脏功能已恢复，他定期接受医疗团队的随访。尽管目前这种情况不太常见，但对于出现咽部症状及随后心脏表现（无论有无瓣膜功能障碍）的患者，临床医生在鉴别诊断时应考虑链球菌性咽炎和ARF。ARF的一级和二级预防对于维持该疾病的低发病率至关重要。
