Key result
Anti-inflammatory and heart failure therapies reverse severe biventricular dysfunction from recurrent acute rheumatic fever.
Why the study?
Recurrence of acute rheumatic fever in adults, particularly after valve surgery, is rare but clinically significant.
Case Report (n=1)
No
Recurrent acute rheumatic fever can cause severe myocardial dysfunction without prosthetic pathology in adults post-valve replacement and requires prompt recognition with multimodality imaging.
Suggests recurrent ARF evaluation in post-valve RHD patients with new biventricular dysfunction; leaves open prospective validation of management.
BACKGROUND: Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity in endemic regions. Recurrence of acute rheumatic fever (ARF) in adults, especially after valve surgery, is rare but clinically significant. CASE SUMMARY: A 44-year-old man with rheumatic mitral stenosis underwent mechanical mitral valve replacement. He presented 5 years later with dyspnea, orthopnea, and fatigue. Echocardiography showed new severe biventricular systolic dysfunction (left ventricular ejection fraction 20%) with preserved prosthetic function. Coronary computed tomography angiography excluded obstructive disease, and pulmonary embolism was ruled out. Elevated inflammatory markers raised suspicion for recurrent rheumatic carditis. He received anti-inflammatory therapy and guideline-directed medical therapy for heart failure, with progressive recovery. DISCUSSION: Recurrent ARF should remain a diagnostic consideration in adults with prior RHD and new ventricular dysfunction, even after valve replacement. TAKE-HOME MESSAGES: Recurrent ARF may occur post-surgery and cause myocardial dysfunction. Echocardiography and multimodality imaging are essential for diagnosis and management.
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Borges et al. (2025) conducted a case report in Recurrent rheumatic carditis (n=1). Anti-inflammatory therapy and guideline-directed heart failure therapy was evaluated. Recurrent acute rheumatic fever caused severe biventricular dysfunction despite a normally functioning mechanical mitral valve, improving with anti-inflammatory and heart failure therapies.
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