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Ann Thorac Surg 2004;78:699-701
© 2004 The Society of Thoracic Surgeons

Case report

Recurrent acute rheumatic fever: a forgotten diagnosis?

Isaac S. Kadir, FRCSa*, Thomas A. Barker, MRCSa, Bernard Clarke, FRCPb, Helen Denley, MRCPathc, Geir J. Grötte, FRCSa

a Departments of Department of Cardiothoracic Surgery, Manchester, UK
b Department of Cardiology, Manchester, UK
c Department of Pathology, Manchester Royal Infirmary, Manchester, United Kingdom

Accepted for publication June 23, 2003.

* Address reprint requests to Dr Kadir, Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL UK
e-mail: ikadir{at}aol.com

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.






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