Medical Emergencies · patient case question
Rheumatic fever characteristically damages which two systems?
Patient case: Rheumatoid arthritis with a prosthetic mitral valve
Patient: Female, 62 years old
Chief complaint: “I need a tooth taken out.”
History: Rheumatic fever in childhood. Mechanical mitral valve replacement six years ago. Rheumatoid arthritis managed with weekly methotrexate. Warfarin, stable.
Findings: Non-restorable tooth #14 with a chronic apical abscess. No acute swelling. Reduced grip strength and limited manual dexterity.
Show answer and explanation
Correct answer: B. The heart and the joints
- A. Liver and spleen are not affected by rheumatic fever.
- B. CORRECT. Acute rheumatic fever is an immune sequela of Group A streptococcal pharyngitis, in which antibodies cross-react with host tissue. CARDITIS is the consequence that matters long-term — valvulitis scars the mitral valve above all, then the aortic — and migratory POLYARTHRITIS of the large joints is the most common acute feature. The Jones criteria capture both, alongside chorea, erythema marginatum and subcutaneous nodules.
- C. Renal involvement follows a DIFFERENT streptococcal complication, post-streptococcal glomerulonephritis. The lungs are not a rheumatic fever target.
- D. Erythema marginatum is a skin sign, but the skin is not a damaged organ system, and peripheral nerves are not involved. Sydenham chorea reflects central, not peripheral, involvement.
Note: Mnemonic for the major Jones criteria — J♦NES: Joints, ♦ carditis, Nodules, Erythema marginatum, Sydenham chorea.
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