BMJ Case Reports 2017; doi:10.1136/bcr-2016-218954

Rheumatic fever with severe carditis: still prevalent in the South West Pacific

  1. Bruno Pagis3
  1. 1Medicine, King's College London, London, UK
  2. 2Auckland City Hospital, Auckland, New Zealand
  3. 3Centre Hospitalier de la Polynesie Francaise, Papeete, French Polynesia
  1. Correspondence to Taran K Nandra, taran.nandra{at}
  • Accepted 26 February 2017
  • Published 10 March 2017


Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.


  • Contributors TKN, NJW and JA are responsible for substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. TKN, NJW and BP are responsible for drafting the work or revising it critically for important intellectual content. TKN, NJW, BP and JA are responsible for final approval of the version to be published. TKN, NJW, BP and JA are responsible for agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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