Acute rheumatic fever

Case contributed by David Preston
Diagnosis probable

Presentation

This Indigenous Australian was admitted to a rural hospital with high fevers and shortness of breath. Originally treated as having pneumonia.

Patient Data

Age: 16 years
Gender: Male
x-ray

Plain chest film shows bilateral increased interstitial markings. Heart shadow is obscured although appears enlarged. Left sided pleural effusion noted.

After referral to a tertiary hospital, the patient was intubated and required inotropes. An echo was obtained which showed torrential regurgitation of the mitral and aortic valves. A diagnosis of rheumatic heart disease was made. Treatment included high dose aspirin.

x-ray

The patient is intubated and ventilated. Cardiomegaly is now clearly seen. 

The patient went to theater for mitral and aortic valve replacement. 

x-ray

Post thoracotomy. Valvular protheses noted. ETT, NGT, CVC and intercostal catheter present. 

Case Discussion

Recovery was swift and transfer to the ward then back home soon followed.

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