An 11-year-old Aboriginal boy from a remote community has migratory ankle and knee pain, fever and a new apical pansystolic murmur. ESR is high and

Question

An 11-year-old Aboriginal boy from a remote community has migratory ankle and knee pain, fever and a new apical pansystolic murmur. ESR is high and antistreptolysin O titre is elevated. Echocardiogram shows mitral regurgitation. What is the most appropriate management?

Accepted Answer

Treat acute rheumatic fever and commence secondary benzathine penicillin prophylaxis

Answer

Treat as juvenile idiopathic arthritis with methotrexate

Answer

Delay antibiotics until throat culture confirms group A streptococcus

Answer

Use short-course oral antibiotics without follow-up

Answer

Reassure that viral arthralgia explains the findings

Acute rheumatic fever — RACP Paediatrics MCQ

An 11-year-old Aboriginal boy from a remote community has migratory ankle and knee pain, fever and a new apical pansystolic murmur. ESR is high and antistreptolysin O titre is elevated. Echocardiogram shows mitral regurgitation. What is the most appropriate management?