Takayasu arteritis in a patient diagnosed with acute rheumatic fever presenting with carditis: Is it a coincidental association or an aetiological relationship?

Abstract

A 14-year-old girl was admitted to our department with fatigue and arthralgia 3 weeks after an upper respiratory tract infection. Pain appeared first in the right knee followed by the left elbow 2-3 days later; at the time of presentation, pain had been ongoing for 2 weeks.The body temperature at presentation was 36.6 C, pulse rate 96 beats/min, respiratory rate 24/min and blood pressure measured from the right arm 110/60 mmHg. Cardiac auscultation revealed cardiac murmurs included a grade 4/6 pan-systolic component and a grade 2/6 early diastolic component at the apex, with radiation to the left axilla. Echocardiography revealed moderate mitral and aortic insufficiency; the left atria and ventricle were dilated. Haemoglobin level was 101 g/L, leukocyte count 8700/mm 3 (neutrophil predominance), erythrocyte sedimentation rate (ESR) 68 mm/h, C-reactive protein level 92.2 mg/L and antistreptolysin O (ASO) titre 1126 IU/L. The patient was diagnosed with acute rheumatic fever (ARF) based on the revised