Acute Rheumatic Fever in an Adult Female Patient Presenting With Chest Pain: A Case Report

Acute rheumatic fever (ARF) is an autoimmune disease triggered by group A <i>Streptococcus</i> (GAS) infection, predominantly affecting children in low- and middle-income countries. Although its incidence has significantly decreased in the United States (US), ARF remains a major cause of morbidity and mortality worldwide due to complications like rheumatic heart disease (RHD). The condition arises from molecular mimicry, where the immune system targets host tissues after a GAS infection, leading to inflammation and potential damage to the heart, joints, and nervous system. Early diagnosis and treatment, including antibiotics and anti-inflammatory drugs, are crucial to managing ARF and preventing recurrent episodes and long-term complications like RHD. A 39-year-old female patient with a history of recurrent streptococcal pharyngitis and allergy to penicillin presented with three days of fever, sore throat, and left wrist pain and one day of chest pain. Physical examination revealed pharyngeal erythema and tonsillar exudates with no abnormal heart sounds or subcutaneous nodules. Laboratory tests confirmed a positive rapid strep test, elevated inflammatory markers, and an elevated troponin-I level, suggesting carditis. Given the clinical findings, including two major and two minor Jones criteria, the patient was diagnosed with ARF and administered azithromycin, naproxen, and dexamethasone in the emergency department. An inpatient echocardiogram revealed no significant valvular disease, and the patient was discharged on a 10-year course of prophylactic azithromycin. While ARF remains a significant public health issue affecting children in developing countries and is driven by socioeconomic factors and inadequate healthcare access, it is much rarer in adult patients residing in the continental US. The pathogenesis involves an autoimmune response to GAS, leading to multisystem involvement. Diagnosis relies on assessing the presence of clinical revised Jones criteria, and management focuses on treating the acute infection, controlling inflammation, and preventing disease recurrence and progression through long-term antibiotic prophylaxis. Patients with suspected carditis should be further evaluated for RHD. Continued research and improved healthcare strategies are essential to reduce the global burden of ARF and RHD.