Rheumatic fevera vignette
R. L. Boon and
E. Baildam1
Musgrove Park Hospital, Paediatrics, Taunton and 1 Booth Hall Children's Hospital, Rheumatology, Manchester, UK
Correspondence to: R. L. Boon. E-mail: robboon69{at}hotmail.com
SIR, A 12-yr-old boy presented with 7 weeks of arthralgia, affecting the knees, cervical spine and small joints of both hands, and pain in the palms of both hands with reduced flexion of the second, third and fourth fingers.
He was initially apyrexial but subsequently developed a temperature of 38°C. He was pale with cervical lymphadenopathy. A nodule was noted over the lateral epicondyle of his left elbow. He had tenosynovitis affecting the palms, fixed flexion deformities of the second, third and fourth fingers of both hands (Figs. 1 and 2) and a reduced range of movement in the cervical spine. Pansystolic and diastolic murmurs were noted.

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FIG. 1. Fixed flexion deformities of the second, third and fourth fingers of the left hand. This figure may be viewed in colour as supplementary data at Rheumatology Online.
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FIG. 2. Fixed flexion deformities of the second, third and fourth fingers of the right hand. This figure may be viewed in colour as supplementary data at Rheumatology Online.
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Investigations showed: haemoglobin 9.9 g/dl (normochromic, normocytic picture), white blood cells (WBC) 9.5 x 109/l, platelets 268, erythrocyte sedimentation rate (ESR) 92 mm/h, C-reactive protein (CRP) 48 mg/l, ferritin normal, urea and electrolytes and liver function tests normal. Complement levels were normal and autoantibodies negative. The ECG was normal. Echocardiogram revealed aortic and mitral valve regurgitation. A throat swab grew group A beta haemolytic streptococcus: anti-DNase 360 unit/ml (normal <240), antistreptococcal antibody titres (ASOT) >800 unit/ml (normal <200).
Rheumatic fever was diagnosed. The patient responded well to aspirin and penicillin. Ongoing tenosynovitis improved with prednisolone. Persistent aortic and mitral valve regurgitation were treated with enalapril.
There have been case reports of tenosynovitis and rheumatic fever in adults [1] but not children.
The authors have declared no conflicts of interest.
References
- Peretz A, Van Laethem Y, Famaey JP. About five cases of acute rheumatic fever in the adult. Clin Rheumatol 1985;4:30811.[CrossRef][ISI][Medline]
Accepted 29 March 2005