INTRODUCTION
Acute rheumatic fever (ARF) is a global disease affecting children aged 5-15, often caused by group A streptococcus infection. Proper management and prophylaxis with penicillin can prevent the recurrence of ARF and the progression to reumatic heart disease (RHD).
CLINICAL CASE
A 7-year-old female patient was admitted to the hospital with migratory oligoarthritis in knees and elbows, persistent fever, and chorea. During the hospitalization period, a systolic murmur at the mitral focus and a diastolic murmur at the aortic focus were detected, which raised the possibility of Acute Rheumatic Fever. The child had a history of recurrent pharyngotonsillitis, with the last episode recorded five months before hospitalization, and elevated inflammatory markers and anti-streptolysin O antibody. The echocardiogram revealed increased valve thickness with rheumatic involvement, vegetation on the mitral valve and severe mitral and aortic regurgitation. Antibiotic therapy and corticosteroid treatment were initiated due to carditis and infectious endocarditis, but the patient exhibited persistent heart failure symptoms. Double mitroaortic valve replacement surgery was necessary. The patient's echocardiogram showed improved prostheses, but new worsening chorea, fever, and odynophagia raised suspicion of acute rheumatic fever recurrence, prompting the reinforcement of Penicillin prophylaxis.
CONCLUSION
ARF has an impact on the lives of children, as demonstrated by this case, which required a double valve replacement surgery. This case highlights the persistent need for monitoring, the and proper treatment with Penicillin for the treatment of acute cases and for secondary prophylaxis, which enables the reduction of progression to RHD and the prevention of disease recurrence.