Acute Rheumatic Fever in the Elderly: A Case Report

Abstract

          Acute rheumatic fever (ARF) is almost all diagnosed in children and young adolescents in developing countries and it has been rarely recognized in the adults of more than 4^th decade of age. Herein, we report a case 67-year-old Thai man who presented with acute onset of acute dyspnea, orthopnea and fever for one day. He had the history of poorly controlled diabetes for a few years. The physical examination revealed BP 198/130 mmHg, P 130/min, crepitation of both lower lung fields, pansystolic murmur at the lower sternal border and edema of both legs and scrotums. The initial blood sugar was 581 mg%. He responded well diuretic tests, vasodilatation and insulin. On the third day of admission, he developed chorea of left hand with the rising of ESR and ASO titer while his blood sugar was 235 mg%. The studies of cardiac enzymesand the EKG were unremarkable. The echocardiogram showed dilated LV, global hypokinesia with moderate LV function, ejection fraction of 34.6 %, and mild MR without vegetation. The cardiac catheterization revealed only mid portion of LAD tubular 65 % lesion.The CT of the brain was uneventful. The diagnosis of ARF was added. However he did notaccept further treatments or investigatios. Our case seems to suggest that the ARF should not be forgotten in the case of fever and heart failureof unknown etiology even in the elderly and thelife-long secondary prevention of recurrent rheumatic fever with antibioticis valid if only one episode of ARF is established in the last few decades of life.