RHDnet – Members’ Discussion Forum Update
In the last edition of Heart Beat RHDnet introduced its first clinical case presenter, Dr Andrew Steer. Join the case discussion, which focuses on an atypical presentation of acute rheumatic fever in a child, and share your knowledge and experience with others working in the field.
CASE PRESENTATION
Whilst in Fiji, we had several cases where children presented with fever and pain/swelling in a single joint that was diagnosed as a case of septic arthritis and managed as such.
The joint fluid was aspirated and no bacteria were cultured. However, no alternate diagnoses were considered and these children were treated with intravenous antibiotics as per septic arthritis.
Three of these children were subsequently diagnosed with rheumatic heart disease (of moderate severity or worse), looking back through their histories we feel that it is likely that the episode of fever and mono-arthritis managed as septic arthritis was in fact the primary episode of rheumatic fever.
Obviously the potential to start secondary prophylaxis was missed in these children.
The diagnosis of rheumatic fever is difficult, particularly when only one joint is involved. We published these three cases, and we know of other similar cases reported from the US.
- Have other clinicians observed this?
- If a child with suspected septic arthritis has a sterile joint, do you then do a work-up for acute rheumatic fever (ASOT, ECG, echocardiogram)?
- Are the orthopaedic surgeons that you work with aware of acute rheumatic fever?
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Join the Forum and share your expertise
Acute rheumatic fever is still common in many developing countries, and among some indigenous groups in developed countries. In order to maximise the discussion around this case presentation it will be available in the Forum for the next two months.
New members can register by submitting an RHDnet Contact Form and selecting “Register for Members’ Forum” in the subject line.
For more information: www.worldheart.org/rhd or email rhdnet(at)worldheart.org
