Rheumatic Pneumonia: Reappearance of a Previously Recognized Complication of Acute Rheumatic Fever

Sj, Burgert; Dc, Classen; Jp, Burke; Lg, Veasy

doi:10.1093/clinids/21.4.1020

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Rheumatic pneumonia affects about 2% of patients, most often with carditis, and remains a diagnosis of elimination [ 7 ]. The clinical picture is that of acute pneumonia, with dyspnea, non-productive cough, fever, and varying degrees of chest pain [ 3 ]. Several radiographic aspects have been described, including nodular involvement, diffuse infiltrates, pleural effusions, and condensation areas [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Rheumatic Fever Revealed by Pulmonary Involvement: A Case Report

Mougui¹,

Bouchti²

2023

Cureus

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Rheumatic fever (RF) is a significant public health problem in underdeveloped countries, and its diagnosis is based on modified Jones criteria. However, there are rare manifestations not included in these criteria that can complicate this condition. We present a case report of a 21-year-old Moroccan female with RF revealed by pulmonary involvement. The patient had no known rheumatic fever. She presented with a two-week history of joint pain, severe chest pain, and shortness of breath. On clinical examination, she was febrile with a palpable left knee joint effusion. Laboratory tests indicated elevated levels of inflammation markers and moderate hepatic cytolysis. The thoracic CT scan revealed extensive bilateral alveolar-interstitial parenchymal involvement. The left knee joint puncture showed an inflammatory fluid without germs or microcrystals. Antibiotic therapy with ceftriaxone and gentamycin was ineffective. Echocardiography revealed rheumatic poly valvulopathy with mitral valve narrowing and moderate to severe mitral insufficiency. Streptolysin O antibody levels were high. The diagnosis of RF complicated by rheumatic pneumonia was made. Treatment with amoxicillin and prednisone led to favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations include joint, cardiac, skin, and sometimes neurological involvement [ 1 ]. Pulmonary involvement is a rare and poorly understood complication [ 3 ]. This report is of a case of RF revealed by pulmonary involvement in a 21-year-old Moroccan female.…”

Section: Introductionmentioning

confidence: 99%

Rheumatic Fever Revealed by Pulmonary Involvement: A Case Report

Mougui¹,

Bouchti²

2023

Cureus

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“…We offer this case of rheumatic pneumonia as an example of a rapidly progressive case of ARF with multiorgan involvement. The most recent report of this entity from a search of Ovid MedLine and Pubmed is from 2005 with seven English-language reports in the preceding two decades ( Table 2) [7][8][9][10][11][12][13][14][15][16]. Our patient's presentation was severe and somewhat atypical, as there was significant anemia with a history of recent weight loss.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Involvement in Acute Rheumatic Fever: A Case Report and Literature Review

Kenney

McMullin

Abdul-Aziz

2020

Cureus

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Rheumatic pneumonia is a pulmonary complication of rheumatic fever, often with grave outcomes. It has been described sporadically in literature, most recently a decade ago. Here, we describe a case of a 12-year-old Native American girl presenting with chest pain, gastrointestinal complaints, and frequent nosebleeds. After the initial diagnosis with acute pericarditis, she was found to meet diagnostic criteria for rheumatic fever. Revised Jones criteria met included significantly elevated streptolysin O antibody and anti-DNase B, carditis, arthralgia, fever, and elevated inflammatory markers. Findings complicating the diagnosis were an elevated antinuclear antigen with a family history of systemic lupus erythematosus (SLE), hemoptysis, and a chest CT finding of right lower lobe alveolar hemorrhage as well as rightsided mediastinal adenopathy. The patient was discharged on day nine of admission after a course of high-dose methylprednisolone with prednisone taper, furosemide, enalapril, naproxen, monthly penicillin G injections, and multidisciplinary outpatient follow-up. A repeat chest CT scan three months later showed significant improvement. The pulmonary findings described in our patient are consistent with prior reports of rheumatic pneumonia, however, most prior cases described did not include high-resolution imaging. Our patient recovered well aside from complications secondary to mitral regurgitation, unlike many patients seen in our literature search who died due to early or later complications of pulmonary disease. Although acute rheumatic fever, and its pulmonary complications, is significantly less common than it once was, it remains a disease entity that should remain on the differential for multisystem rheumatic complaints.

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“…Thus unusual complications, such as RP, are a challenging diagnosis for clinicians without experience of this illness 4. To the best of our knowledge, only six isolated case reports have been reported in English or Spanish over the past 20 years (table 1).…”

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confidence: 99%