RHEUMATIC FEVER: A DISEASE THAT SHOULD NOT YET BE FORGOTTEN

Objective: Although the incidence of acute rheumatic fever (ARF) has significantly decreased, individually reported outbreaks of the disease still occur in developed countries. The aim of this report is to present three patients with an initial attack of ARF, treated in the Department for Allergology, Rheumatology and Clinical Immunology during 2012 and 2013. Methods: The medical records of these three patients with ATF – who were treated in our department during the abovementioned period, and whose diagnoses were established according to the revised Jones criteria from 1992 – were reviewed. Results: Of the three patients, two were female (13 and 17 years old) and one was male (9 years old). Clinical and laboratory data were: migrating arthritis (3); carditis (1); fever (3); raised inflammatory markers – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (3) – and a prolonged PR interval on electrocardiogram; and first-degree heart block (3). All patients had elevated antistreprolysin titres and all were evaluated by echocardiography. One patient had mitral regurgitation. We introduced streptococcus eradication therapy with penicillin, therapeutic doses of aspirin, corticosteroids (for the patient with carditis) and secondary prevention of streptococcal infections with 4-weekly doses of benzathine penicillin G. Patients have been monitored as outpatients, and as yet there is no evidence of recurrence of the disease or its complications. Conclusion: ARF still occurs occasionally in developed countries. It is a disease that has not been eradicated, and this should not be forgotten in our efforts to reduce long-term morbidity and mortality.