Stroke as First Presentation of Rheumatic Heart Disease in Pediatric Age Group – a Case Report from Developing Country, Rwanda

Temesgen Tsega Desta,1,2 Mugwaneza Kalisa Peace,2 Johnson Kayihura2 1Rwanda Military Referral and Teaching Hospital (RMRTH), Kigali, Rwanda; 2Department of Pediatrics and Child Health, University of Rwanda, Kigali, RwandaCorrespondence: Temesgen Tsega Desta, Email [email protected]: Rheumatic heart disease (RHD), a chronic consequence of acute rheumatic fever, rarely presents with stroke as an initial manifestation in children. This report shows a rare scenario where ischemic stroke was the first clinical presentation of underlying RHD.Case Presentation: A 10-year-old boy presented with seizures, hemiplegia, and expressive aphasia. Echocardiography revealed rheumatic mitral valve disease with a vegetation. Neuroimaging showed multifocal cerebral infarctions suggestive of cardioembolism.Conclusion: This case emphasizes the importance of echocardiographic screening in pediatric patients presenting with stroke, particularly in endemic regions where subclinical RHD may go undiagnosed.Keywords: rheumatic heart disease, pediatric stroke, cardioembolism, subclinical RHD