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Acute rheumatic fever — RACP Adult Medicine MCQ

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HardInfectious diseasesAcute rheumatic feverRACP Adult Medicine

A 14-year-old Aboriginal boy from a remote community has fever, migratory polyarthritis and a new apical pansystolic murmur 3 weeks after sore throat. ESR is elevated and antistreptolysin O titre is high. ECG shows prolonged PR interval. What is the most likely diagnosis?

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Correct answer: E — Acute rheumatic fever

Migratory polyarthritis, carditis, prolonged PR interval and evidence of recent streptococcal infection in a high-risk population are consistent with acute rheumatic fever. Viral myocarditis does not explain migratory arthritis with streptococcal serology. JIA, septic arthritis and SLE are less consistent with the Jones-criteria pattern.

Reference: Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and RHD; eTG