Prolonged PR interval in a patient with acute rheumatic fever

A previously healthy, 11-year-old boy presented to the emergency department with fever and polyarthritis of 7-days duration. His vital signs were body temperature 39.5 °, heart rate 90/min, blood pressure 108/53 mmHg, respiratory rate 22/min and oxygen saturation 98% on room air. Physical examination revealed polyarthritis in the bilateral knees, left elbow and right ankle. Subcutaneous nodules, heart murmur and chorea were denied. Electrocardiography showed a p rolonged PR interval (Figure  1a), and echocardiography revealed trivial aortic valve regurgitation. Laboratory data demonstrated elevated inflammatory markers (C-reactive protein: 218  mg/l) and a high antistreptolysin O titer. Based on these findings, we diagnosed acute rheumatic fever (ARF) in accordance with the revised Jones criteria.1 On the next day after naproxen and amoxicillin treatment, the fever and arthritic symptoms resolved dramatically. The electrocardiography findings also normalized between days 1 and 16 (Figure  1b and c). The patient recovered without severe cardiac complications and received naproxen for 4 weeks. Prophylaxis with oral penicillin until age 21  years was planned.
Source: QJM - Category: Internal Medicine Source Type: research