Treatment of Acute Rheumatic Carditis with Choline Magnesium Trisalicylate in a Patient Needing Surgery

Abstract

Acute rheumatic fever is a post-infectious illness characterized by diffuse inflammation. Typically, high-dose anti-inflammatory agents are used as primary therapy for this disorder. In addition to their anti-inflammatory properties, these agents, most frequently aspirin, also have anti-platelet properties. We describe the case of an 11-year-old patient with rheumatic fever who needed to undergo surgery. The use of traditional anti-inflammatory agents would have posed a potential problem with postsurgical bleeding, so a lesser-used anti-inflammatory agent (i.e., choline magnesium trisalicylate) was selected.KEYWORDS: acute rheumatic carditis, anti-inflammatory, choline magnesium trisalicylate, pediatric, Trilisate 2003;8:284-6 An 11-year-old male with a history of Trisomy 21 and obesity presented to our hospital with complaints of shortness of breath and tachypnea. He had no known history of congenital heart disease. On review of systems, he had a 1-month history of arthralgias but did not have any history of fever or sore throat. In addition, he had a prolonged history of loud breathing during sleep and occasional apnea. His vital signs were notable for mild desaturation with a room air oxygen saturation of 88%. J Pediatr Pharmacol TherHis physical examination was remarkable for facies consistent with Trisomy 21, obesity, tonsillar hypertrophy, diminished breath sounds at his lung bases bilaterally, and quiet heart sounds with an intermittent III/VI holosystolic murmur heard best at the apex. There were no diastolic murmurs. His liver edge was palpable approximately 3-4 cm below the right costal margin. His chest radiograph showed an enlarged cardiac silhouette, bilateral pleural effusions, and increased pulmonary vascular markings. His laboratory studies were remarkable for an elevated erythrocyte sedimentation rate (ESR) of 106 mm/ hour (nl=0-20 mm/hour), an elevated C-reactive protein of 8.4 mg/dL (nl=0-1 mg/dL), and an elevated antistreptolysin (ASO) of 400 IU/mL (nl <250 IU/mL). An echocardiogram performed showed normal intracardiac anatomy with severe aortic regurgitation, moderate mitral regurgitation, no evidence of vegetations, a dilated left atrium and left ventricle, and good left ventricular function. His left ventricular shortening fraction was 41%, and he had qualitatively good right ventricular function.He met the criteria for acute rheumatic fever (major criteria = carditis, 2 minor criteria = elevated ESR and history of arthralgias, and evidence of recent streptococcal infection = elevated ASO).