Article in Japanese

A case of acute rheumatic fever with group A Streptococcus emm type1

Hibiki DOI¹⁾, Chie IMAI¹⁾, Satoi NII¹⁾, Shinichi SUMIMOTO¹⁾

A 6-year-old boy was admitted to this hospital with chief complaints of migratory arthralgia and fever. Pharyngeal group A Streptococcus infection was confirmed, and laboratory test results revealed elevated inflammatory marker levels. PR prolongation on electrocardiogram also was noted, and the patient received a diagnosis of acute rheumatic fever. Arthralgias and fever were relieved immediately with oral naproxen. Echocardiography revealed mitral valve regurgitation, and prednisolone was administered to treat carditis. The PR prolongation and mitral regurgitation improved gradually. After discharge, arthralgias and fever recurred when naproxen and prednisolone were discontinued; and a temporary course of naproxen improved these symptoms. Ampicillin was administered for resolving the group A Streptococcus infection; Benzylpenicillin benzathine was continued as a secondary prophylaxis. Group A Streptococcus emm type 1 was isolated from the patient's throat culture; this microorganism is often macrolide resistant. Penicillin was suggested as adequate treatment of group A Streptococcus infections. Moreover, collecting data about bacterial strains associated with acute rheumatic fever is required because such strains are reported rarely in Japan.

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1) Department of Pediatrics, Osaka Red Cross Hospital

Key words	acute rheumatic fever, group A Streptococcus, emm1
Received	April 24, 2020
Accepted	August 1, 2020

32 (4)：369─374,2020