Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP784

Poster Presentation

8 YEARS OLD BOY WITH RHEUMATIC HEART DISEASE

MILDA INAYAH,THRISIA WURIYANTI,RIA ASHRIYAH RSUD DR KANUJOSO DJATIWIBOWO BALIKPAPAN

Background : Acute rheumatic fever and rheumatic heart disease are thought to result from an autoimmune late response of Streptococcal group A infection. Rheumatic heart disease is a condition that causes permanent damage to the heart valves, which is the most serious complication of rheumatic fever. Case Presentation Summary : A 8 year old male presented to the emergency room with dyspnea since 3 days before hospitalization and get worsening. He also experienced cough in 3 weeks and fever in 2 weeks. He was fully conscious with blood pressure 124/68mmHg, heart rate 152x/minutes, respiration rate 60x/minutes, temperature 38oC, and oxygen saturation 98. There were pharynx hyperemic, retraction of intercostal and subcostal, rhonchi and murmur sound can be revealed. Chest x-ray revealed cardiomegaly. Electrocardiographic showed sinus tachycardia, and the echocardiography showed mitral regurgitation moderate to severe caused by PML prolapse, severe aortic regurgitation, and minimal pericardia effusion. Laboratory examination showed leukocytosis, elevated of CRP and ESR value and positive ASTO. The patient was treated by Penicillin Benzatine G 1.200.000 Unit, furosemide 20mg/8hours, spironolactone 25mg/24hours, captopril 25mg/8hours, digoxin ½ tab/12hours, prednisone 15mg/6hours, and nebulizer with 2cc of NaCl 0,9%/6hours. Learning Points/Discussion : In this case we can found the significant murmur which is suggestive of mitral and aortic regurgitation and unexplained cardiomegaly with congestive heart failure, which is can conclude as clinical sign of carditis, one of mayor manifestation of rheumatic fever. With carditis as the mayor manifestation, fever, elevated of ESR and CRP as the minor manifestation, and supporting by positive ASTO as evidence of preceding group A streptococcal infection, we can treated the patient as rheumatic heart disease. Which is based on jones criteria for primary rheumatic fever 2 mayors or 1 mayor and 2 minors supported by evidence of preceding group A streptococcal infection fulfilled.

Keywords: rheumatic heart disease rheumatic fever cardiomegally jones criteria