A patient reports having had rheumatic fever as a child. Which long-term consequence should you anticipate?

Correct answer: D. Damage to cardiac valves and residual joint involvement

• A. The causative organism is streptococcal, not staphylococcal.
• B. The organism is a bacterium — Streptococcus pyogenes — not herpes simplex virus.
• C. Rheumatic fever does not target the liver; hepatic involvement is not a feature.
• D. CORRECT. Acute rheumatic fever is an autoimmune sequela of untreated GROUP A BETA-HEMOLYTIC STREPTOCOCCAL pharyngitis. Antibodies raised against streptococcal M protein cross-react with host tissue (molecular mimicry), attacking heart, joints, skin and brain. The lasting damage is RHEUMATIC HEART DISEASE — valvular scarring, most often MITRAL STENOSIS. The migratory polyarthritis is characteristically non-deforming.

Note: Dental relevance: patients with rheumatic heart disease are NOT in the current AHA prophylaxis category unless they have a prosthetic valve, prior infective endocarditis, or specified congenital heart disease. Confirm valve status with the cardiologist rather than assuming.