PT  - JOURNAL ARTICLE
AU  - Asim Khan
AU  - Nurhan Sutcliffe
AU  - Ali SM Jawad
TI  - An old disease re-emerging: acute rheumatic fever
AID  - 10.7861/clinmedicine.18-5-400
DP  - 2018 Oct 01
TA  - Clinical Medicine
PG  - 400--402
VI  - 18
IP  - 5
4099  - http://www.rcpjournals.org/content/18/5/400.short
4100  - http://www.rcpjournals.org/content/18/5/400.full
SO  - Clin Med2018 Oct 01; 18
AB  - We present the case of a 41-year-old Australian woman with a 3-day history of fevers and migratory polyarthritis. Three weeks prior she had been treated by her GP with phenoxymethylpenicillin for acute tonsillitis. Examination confirmed synovitis. Systemic assessment including cardiovascular, neurological and skin examination was unremarkable. Abnormal investigations included a leucocytosis with neutrophilia, C-reactive peptide of 116 mg/L, erythrocyte sedimentation rate of 103 mm/hour and acute transaminitis. The antistreptolysin O titre was 304 IU, which increased to 1,250 IU after 2 weeks. Troponin T, electrocardiogram and echocardiography were all normal. The patient was treated for acute rheumatic fever with corticosteroids and a 10-day course of cephalexin. After 8 weeks, she made a full recovery and had normalised inflammatory markers and liver biochemistry. She was then commenced on monthly prophylactic intramuscular benzathine penicillin. This case study aims to raise awareness of the presentation, diagnosis and management of acute rheumatic fever.