G593(P) Case report: an unusual presentation of rheumatic fever in a 3 year old child in the UK

• Published in: Archives of disease in childhood 2020-10, Vol.105 (Suppl 1), p.A213-A213
• Main Authors: Miller, TM, Blundell, DB, Aung, YA, Kona, AK, Emonts, ME
• Format: Article
• Language: English
• Subjects: Arthralgia; Cardiovascular diseases; Case reports; Coronary artery disease; Diagnosis; Digital imaging; Erythema; Exanthema; Heart diseases; Quality of life; Rheumatic fever; Rheumatic heart disease; Ventricle; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-rcpch.510

We describe an unusual presentation of a 3-year-old to a UK District General Hospital with symptomatology initially thought to represent a viral illness, however, was subsequently diagnosed with acute rheumatic fever. The patient had a 6-week evolving presentation favouring the diagnosis which included a rash, followed by an elevated streptolysin titre and arthralgia, then finally a fever with an associated pan-systolic murmur. The difficulty with diagnosis was that these symptoms were occurring in a young patient over an extended period of time and acute rheumatic fever is rare in toddlers.The young child was transferred to the local tertiary centre for further management; however, she went on to develop acute left ventricular failure. Rheumatic fever can lead to rheumatic heart disease which can have long term health outcomes for patients such as demonstrated in this case report.The district general hospital and the tertiary centre reviewed practice and discussed discrepancies around the diagnosis of this case. Following transfer to the tertiary centre, the team recalled the history and identified images that the parent had documented of a typical erythema marginatum rash; this was not visualised at the time of admission. This raised an interesting point around the power of digital imaging in today’s practice for aiding diagnosis.Throughout the course of the condition the child’s parent continued to raise concerns which was invaluable in obtaining the right diagnosis for the child.Take-home messagesAlways be willing to re–evaluate diagnosis and listen to parental concernsThis case illustrates the need to be vigilant for the presentation of rare illness as they can have a significant impact on the quality of life of young patientsDigital imaging can play a vital role in diagnosis of serious diseases