Snapshot A 13-year-old-boy presents with 3 days of malaise, painful joints, nodular swelling over his elbows, low-grade fever, and a rash on his chest and left shoulder. Two weeks ago he was seen for a sore throat. Introduction A sequela of pharyngeal streptococcal infection caused by Group A, Beta-hemalytic S. pyogenes pharyngitis An autoimmune disease caused by cross-reactions between Strep antigens and the antigens on joint and heart tissue Rheumatic fever is a systemic immune process may or may not lead to RHD RHD is a valvular abnormality secondary to rheumatic fever most often manifesting as mitral stenosis Presentation Symptoms presents 1-2 weeks after a Group A Strep infection (usually pharyngitis) with any combination of a variety of symptoms that together lead to diagnosis Jones criteria used to diagnose RHD evidence of a preceding group A streptococcal infection plus two major critertia or one major and two minor criteria Major criteria (PECCS) Minor criteria Migratory polyarthritis Carditis (myocarditis, pericarditis) Erythema marginatum Subcutaneous nodules Chorea Fever Antecedent strep infection Arthralgias Elevated ESR Prolonged PR internal Evaluation Labs positive rapid antigen testing positive ASO and/or DNAase B elevated ESR Imaging Doppler echocardiography may demonstrate valvular insufficiency or ventricular dysfunction Heart catheterization only indicated in cases of chronic disease to evaluate mitral and aortic valves and potentially balloon stenosed valves EKG sinus tachycardia in most cases may demonstrate sinus bradycardia in patients with decreased vagal tone can show varying degrees of heart block depending on severity of case Differential RA, SLE, endocarditis, osteomyelitis, Lyme's Disease, Sickle cell disease, any variety of isolated valvular disorders Treatment Pharmacologic Penicillin V indicated for treamtent of acute rheumatic fever Clindamycin indicated for chronic carriers of GABHS Salicylates for fever Prognosis, Prevention, and Complications Prognosis is good if treated acutely Prophylaxis against further streptococcal infection: No evidence of carditis: 5 years or until age 21 (whichever is longer) Evidence of carditis without valvular abnormalities: 10 years or until age 21 (whichever is longer) Evidence of carditis and valvular abnormalitis: 10 years or until age 40 (whichever is longer) Complications depend on severity of disease complete heart block left atrial dilation and atrial fibrillation