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Learning from errors
Case report
Unusual presentation of rheumatic fever in a 3-year-old child in the UK
  1. Taryn Miller1,
  2. Yee Aung2,
  3. David Blundell3 and
  4. Amal Saleh Eldin Seed Ahmed Kona1
  1. 1Paediatric Department, North Cumbria University Hospitals National Health Service Trust, Whitehaven, Cumbria, UK
  2. 2Department of Children and Young People, North Cumbria University Hospitals National Health Service Trust, Whitehaven, UK
  3. 3Department of Paediatric Cardiology, Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, UK
  1. Correspondence to Dr Amal Saleh Eldin Seed Ahmed Kona; akona2000{at}hotmail.com

Abstract

In the developed world, acute rheumatic fever (ARF) is rare. When it does arise, symptoms commonly include fever, arthralgia and rash. We describe a presentation of a 3-year-old child with ARF in a UK District General Hospital. The patient had a 6-week history of diarrhoea, rash and intermittent right hip arthralgia. This was initially thought to be a viral illness until she re-presented with shortness of breath and fever with a pan-systolic murmur. A throat-culture was negative, but an anti-streptolysin titre was elevated, with a bedside echocardiogram demonstrating moderate to severe mitral regurgitation. The young child was transferred to the local tertiary centre for further management; however, she went on to develop acute left ventricular failure. This case illustrates the need to be vigilant for the presentation of a rare illness, such as rheumatic fever, as there can be significant impacts on the quality of life of young patients.

  • paediatrics
  • cardiovascular medicine

https://doi.org/10.1136/bcr-2019-232595

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    Footnotes

    • Contributors TM: constructed the case report by gathering information and reviewing the management of the case in question. Lead conversations across all authors to construct the case report. Interviewed the patients family with regards to management of the case. DB: edited the case report in particular added content to the cardiovascular elements of the report and feedback on the management of the patients case at the teritary centre Provided us with echocardiogram images of the patient in question to deepen understanding of the unusual presentation of the report. YA: edited the case report in particular added content to the cardiovascular elements of the report and provided information on treatment and outcome. ASESAK: lead consultant in the report and was responsible for management of the patient at the local unit. Supervised TM and would provide information on the whole content of the report and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

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