Rheumatic Fever can occur in older patients

Rheumatic heart disease (RHD) is endemic in sub-Saharan Africa where it is the leading cause of cardiovascular mortality in the young. Rheumatic heart disease results from recurrent episodes of acute rheumatic fever (ARF), which are often difficult to diagnose clinically.

Acute rheumatic fever may be diagnosed based on the revised Jones Criteria 2015 for the diagnosis of ARF. Cases of chronic RHD admixed with ARF are very rare and even lesser in patients older than 45 years. Here we report on a 59-year-old patient diagnosed with RHD who underwent elective aortic and mitral valve (MV) replacement and was confirmed histologically to have RHD as well as coincident ARF, with evidence of acute valvulitis. In high-risk areas, consideration of acute rheumatic fever (ARF) in the differential diagnosis should not be ruled out despite not meeting the criteria for definite ARF diagnosis as per revised Jones Criteria 2015. The full paper can be viewed here