{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:40:17Z","timestamp":1756294817516,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,7,1]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>In the developed world, acute rheumatic fever (ARF) is rare. When it does arise, symptoms commonly include fever, arthralgia and rash. We describe a presentation of a 3-year-old child with ARF in a UK District General Hospital. The patient had a 6-week history of diarrhoea, rash and intermittent right hip arthralgia. This was initially thought to be a viral illness until she re-presented with shortness of breath and fever with a pan-systolic murmur. A throat-culture was negative, but an anti-streptolysin titre was elevated, with a bedside echocardiogram demonstrating moderate to severe mitral regurgitation. The young child was transferred to the local tertiary centre for further management; however, she went on to develop acute left ventricular failure. This case illustrates the need to be vigilant for the presentation of a rare illness, such as rheumatic fever, as there can be significant impacts on the quality of life of young patients.<\/jats:p>","DOI":"10.1136\/bcr-2019-232595","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T03:36:13Z","timestamp":1599708973000},"page":"e232595","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Unusual presentation of rheumatic fever in a 3-year-old child in the UK"],"prefix":"10.1136","volume":"13","author":[{"given":"Taryn","family":"Miller","sequence":"first","affiliation":[{"name":"Paediatric Department, North Cumbria University Hospitals National Health Service Trust, Whitehaven, Cumbria, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2046-6540","authenticated-orcid":false,"given":"Yee","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of Children and Young People, North Cumbria University Hospitals National Health Service Trust, Whitehaven, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Blundell","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4876-0087","authenticated-orcid":false,"given":"Amal Saleh Eldin Seed Ahmed","family":"Kona","sequence":"additional","affiliation":[{"name":"Paediatric Department, North Cumbria University Hospitals National Health Service Trust, Whitehaven, Cumbria, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,9]]},"reference":[{"key":"2025082703580171000_13.9.e232595.1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0140-6736(18)30999-1","article-title":"Acute rheumatic fever","volume":"392","author":"Karthikeyan","year":"2018","journal-title":"Lancet"},{"key":"2025082703580171000_13.9.e232595.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39031.420637.BE"},{"key":"2025082703580171000_13.9.e232595.3","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-5-11"},{"key":"2025082703580171000_13.9.e232595.4","first-page":"CD002227","article-title":"Penicillin for secondary prevention of rheumatic fever","volume":"3","author":"Manyemba","year":"2002","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082703580171000_13.9.e232595.5","unstructured":"Management of sore throat and indications for tonsillectomy. A national clinical guideline. Edinburgh: Scottish inrcollegiate guidelines network (SIGN); methodology 2010."},{"key":"2025082703580171000_13.9.e232595.6","first-page":"321","article-title":"Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases","volume":"88","author":"Topan","year":"2015","journal-title":"Clujul Med"},{"key":"2025082703580171000_13.9.e232595.7","first-page":"50","article-title":"New Zealand guidelines for the diagnosis of acute rheumatic fever: small increase in the incidence of definite cases compared to the American heart association Jones criteria","volume":"126","author":"Wilson","year":"2013","journal-title":"N Z Med J"},{"key":"2025082703580171000_13.9.e232595.8","unstructured":"Sika-Paotonu D , Beaton A , Raghu A , et al . Acute Rheumatic Fever and Rheumatic Heart Disease. 2017 Mar 10 [Updated 2017 Apr 3]. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center, 2016. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425394"},{"key":"2025082703580171000_13.9.e232595.9","unstructured":"Gewitz MH , Baltimore RS . American College of cardiology. revised Jones criteria for acute rheumatic fever. Available: https:\/\/www.acc.org\/latest-in-cardiology\/ten-points-to-Tremember\/2015\/05\/08\/15\/22\/revision-of-the-jones-criteria-for-the-diagnosis-of-acute-rheumatic-fever [Accessed 24 May 2019]."},{"key":"2025082703580171000_13.9.e232595.10","unstructured":"RHD Australia (ARF\/RHD) writing group . The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 3rd edn, 2020."},{"key":"2025082703580171000_13.9.e232595.11","unstructured":"NICE Guideline . Public health England. eHHSore throat (acute): antimicrobial prescribing. Available: https:\/\/www.nice.org.uk\/guidance\/ng84\/chapter\/Terms-used-in-the-guideline [Accessed 24 May 2019]."},{"key":"2025082703580171000_13.9.e232595.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66874-2"},{"key":"2025082703580171000_13.9.e232595.13","first-page":"CD003176","article-title":"Anti-Inflammatory treatment for carditis in acute rheumatic fever","volume":"2","author":"Cilliers","year":"2003","journal-title":"Cochrane Database Syst Rev"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232595","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:58:09Z","timestamp":1756292289000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":13,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,9]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/bcr-2019-232595"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232595","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}