Razi Journal of Medical Sciences

Acute rheumatic fever (ARF) is a complication of group A streptococcus infection. Despite a considerable prevalence diminish especially in modern countries in recent years, it is reported occasionally throughout the world. Unfortunately, this decline in incidence and non-specific presentations may cause physicians not to consider the ARF in differential diagnosis.

A 7 years old girl was admitted to our clinic with a high fever, low back pain and bilateral ankle arthralgia. She had no history of severe diseases and her immunization schedule was complete. On physical examination, she had tachycardia and temperature of 39.7 degrees C. Her initial laboratory tests revealed considerable leukocytosis, increase in C-reactive protein, erythrocyte sedimentation rate and anti-streptolysin O titer. Only prednisolone was used to subside acute myocarditis. One day after initiation of corticosteroid therapy, her temperature significantly decreased and her articular pain was resolved. She was discharged with full recovery on day 7 and prophylactic treatment with Benzathine penicillin injection was recommended.

Despite declining incidence of ARF, because of tendency to develop persistent cardiac valve involvement, it must be considerd as one of the most significant disorders in pediatric practice.