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Rheumatic fever — MRCPCH FOP MCQ

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ModerateCardiologyRheumatic feverMRCPCH FOP

A 10-year-old boy from a high-prevalence country has migratory ankle and knee pain, fever and a new apical pansystolic murmur. He had untreated sore throat three weeks ago and ESR is raised. What is the most likely diagnosis?

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Correct answer: D — Acute rheumatic fever

Migratory polyarthritis, fever, new murmur and recent streptococcal pharyngitis are consistent with acute rheumatic fever. Reactive arthritis would not typically cause carditis with a new murmur. Septic arthritis is usually monoarticular with a toxic child and restricted joint movement. The pearl is that rheumatic fever remains relevant in children who have lived in high-prevalence settings.

Reference: NICE CKS Sore throat acute; WHO rheumatic fever guidance