BMJ Case Reports 2018; doi:10.1136/bcr-2017-223792
  • Unusual presentation of more common disease/injury

Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review of literature

  1. Anita Saxena2
  1. 1Cardiology, All India Institute of Medical Sciences, Newdelhi, India
  2. 2Cardiology, All India Institute of Medical Sciences, Newdelhi, India
  1. Correspondence to Professor Anita Saxena, anitasaxena{at}
  • Accepted 30 January 2018
  • Published 11 February 2018


A 14-year-old boy suffering from chronic rheumatic heart disease came to the emergency department with recurrent episodes of presyncope and syncope. He was found to have complete heart block (CHB) and required temporary pacemaker insertion. Further workup revealed that CHB was secondary to acute rheumatic carditis. His atrioventricular (AV) conduction abnormalities recovered in a stepwise fashion over 5 days while he was being treated with corticosteroids, without the need for permanent pacemaker insertion. This case illustrates that acute rheumatic carditis can rarely present with advanced AV conduction block, which may be reversible.


  • Contributors Both AS and SU equally participated in the analysis and interpretation of data, preparation of manuscript and critically reviewed it for intellectual content and gave final approval for submission.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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