Case:Rheumatic Fever with Caridits and Arthritis

A boy of 7 years with low socioeconomic background presented with intermittent fever migrating polyarthritis( Rt hip- Rt Knee – Rt ankle) and anorexia for 5 weeks with a history of sore throat week from the onset joint pain.

On examination, the patient was toxic, had active swelling and tenderness of the Rt Keen joint grossly and of the left foot mildly, had cardiomegaly,palpable p2, loud second sound and a pansystolic murmur in mitral area of grade III with radiation to the axilla. The patient has no basal creps, hepatomegaly or ankle oedema.







Clinically the patient was diagnosed as Rheumatic Fever with Carditis & Arthritis

His ESR was 80 mmhg, had neutrophilia, Raised ASO titre, Xray with cardiomegaly, ECG with tachycardia and Echo showing mitral incompetence.

Investigation confirms the clinical impression.

The patient was hospitalized, given short term Penicillin, prednisolone which will be followed by aspirin and is given long term penicillin as prophylaxis.

Patient is now improved and waiting for discharge.


Badrud Doza

Link:
Rheumatic Heart Disease- e-medicine
Diagnosis of Active Rheumatic Carditis -Circulation

A case of Rheumatic Chorea

A boy of 8 years presented in outdoor setting with choreotic movements of the limbs of the right side and slurring of the speech for the last one and half months.
He has no h/o sore throat, no joint pain or chest pain.

On examination, he was found alert but emotionally labile and afebrile.

Muscle tone and power of the limb on the right side decreasedBut reflexes normal and gait were found normal
Milkman’s grip- positive, serpentine tounge- absent, supination pronation test normal.


On Investigation- hw was mildly anaemic, ESR slightly raised , TLC & DLC normal, ASo titre 200 iu/ml, Xray, ECG normal, CT –was also found normal .

Patient was provisionally diagnosed as Rheuamtic Chorea.

The patient was treated with Injection pecilicillin, Tab prednisolone, Tab peridol,Tab parkinil, then Tab clobam

The patient responded to treatment and his symptoms alleviated. Patient was on close follow up.

The posibilities of intracranial tumor was excluded on first examination ansl on follow up and recovery of the patient on anti Reumatic treatment and his wellbeing at one year aftyer diagnosis assures the first clinical conclusion.

Diagnosis of Reumatic Chorea is more clinical.

[Footnote: Rheumatic Chorea does not follow the Jones criteria for dianosis.
Rheumatic Chorea as a single manisfestation may indicate Rheumatic fever.
ESR may be low as the inflammatory changes in the brain is minimal.
The clinical manifestation may occur months or years after the initil sterptococcal infection]