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Journal of Tropical Pediatrics Advance Access originally published online on January 21, 2008
Journal of Tropical Pediatrics 2008 54(3):205-207; doi:10.1093/tropej/fmm116
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© The Author [2008]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Case Reports

Acute rheumatic fever: an important differential diagnosis of septic arthritis

Reapi Mataikaa, Jonathan R. Carapetisb,c, Joseph Kadoa and Andrew C. Steerb

aDepartment of Paediatrics, Fiji Ministry of Health, Colonial War Memorial Hospital, Suva, Fiji Islands
bCentre for International Child Health, University of Melbourne, Melbourne 3052, Australia
cMenzies School of Health Research, Darwin 8011, Australia

Correspondence: Andrew C. Steer, Centre for International Child Health, University of Melbourne, c/o Fiji Group A Streptococcal Project, PO Box 18009, Suva, Fiji Islands. E-mail <andrew.steer{at}rch.org.au>.


  Abstract

We present three cases of suspected septic arthritis in which the joint fluid was sterile. Subsequently all three patients were diagnosed with established moderate-severe rheumatic heart disease. In retrospect it is likely that the earlier presentations were in fact episodes of acute rheumatic fever but were not recognized as such. These cases underline the importance of acute rheumatic fever as a differential diagnosis of septic arthritis when the joint fluid is sterile, particularly in regions where there are high rates of acute rheumatic fever and rheumatic heart disease.

Key Words: acute rheumatic fever • septic arthritis • rheumatic heart disease


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