1/120. Acute rheumatic fever with three major criteria: polyarthritis, carditis and chorea. A case report. An eight-year-old girl is presented with three major criteria of acute rheumatic fever: polyarthritis, carditis and chorea. The diagnosis was confirmed with a history of pharyngitis 15 days prior to admission and with the findings of positive acute phase reactants such as elevated erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), elevated anti-streptolysin-O (ASO) titration, and clinical findings of polyarthritis, carditis and chorea. Patient responded well to salicylate and phenobarbital treatment. The rare association of these three major criteria in acute rheumatic fever is emphasized. ( info) |
2/120. Generalized eruptive histiocytoma of childhood associated with rheumatic fever. We describe a widespread papular eruption in a 5-year-old girl with rheumatic fever. Histological examination revealed a dense histiocytic infiltration in the dermis. On immunohistochemical studies, the cells were positive for vimentin, CD68, MAC387, alpha1-antichymotrypsin and lysozyme, but negative for CD1a and S-100 protein. Electron microscopic studies showed no Birbeck granules in their cytoplasm. A diagnosis of generalized eruptive histiocytoma of childhood was established. The skin lesions completely disappeared within 8 months. ( info) |
3/120. The prophylaxis of acute rheumatic fever in a pair of monozygotic twins. The public health implications. Recurrent acute rheumatic fever and rheumatic heart disease can be prevented by antibiotic intervention. We report the case of genetically identical twins, one of whom had overt rheumatic fever, received penicillin prophylaxis and did not have rheumatic heart disease. The other must have had inapparent rheumatic fever, received no chemotherapy prophylaxis and proceeded to develop rheumatic heart disease. A greater clinical and laboratory vigilance is required for the diagnosis of acute rheumatic fever in the asymptomatic identical twin of a patient with rheumatic fever. This case provides further evidence of a genetic predisposition to rheumatic fever and demonstrates the continued value of penicillin in the prophylaxis of acute rheumatic fever. It emphasises the need to maintain the integrity of preventive programmes against rheumatic fever worldwide. Studies which explore the HLA and other genetic linkages with rheumatic fever should be encouraged. ( info) |
4/120. regeneration ad integrum of the condyle head in a patient with temporomandibular disorders. A 14-year-old who had suffered from a beta-hemolytic streptococcus infection presented with serious temporomandibular disorders, including a reabsorption of the condyle head on the right side, and reabsorption in the cavern of the left side. Her masticatory muscles were electronically deprogramed, achieving a mandibular position supported by a relaxed musculature. The patient's signs and symptoms subsequently disappeared. Study of the magnetic resonance image a year later clearly showed a regeneration ad integrum of the condyle head and a spontaneous reinsertion of the articular disk. The results suggest the need for use of electronic elements in order to treat patients with temporomandibular disorders effectively. ( info) |
| Sixteen cases of rheumatic fever from one general practice are described and the indication for prophylactic penicillin is discussed. ( info) |
6/120. Multiple coronary artery aneurysms resulting in myocardial infarction in a young man: treatment by double aorta-coronary saphenous vein bypass grafting. A 26-year-old Japanese man was treated for a transmural myocardial infarct caused by multiple aneurysms of the left main (LMC), left anterior descending (LAD), and the right coronary arteries (RCA). He underwent successful double aorta-coronary saphenous vein bypass grafting. The etiology of the aneurysm remains uncertain but an inflammatory origin is most probable. review of the literature has indicated that this is the seventh case of coronary artery aneurysms without arteriovenous fistulas to be managed by grafting techniques with the saphenous vein. This experience has suggested that young patients presenting with anginal pain or myocardial infarction whould be carefully examined for coronary artery aneurysms. Since most of the patients developed myocardial infarction probably from thrombotic occlusion or embolism of the distal vessel, this lesion should be considered for surgery whenever anatomically feasible. Coronary artery reconstruction by grafting techniques, with or without resection of the aneurysm, is the treatment of choice. Although surgical treatment has provided good clinical amelioration to our patient as well as the patients previoulsy reported, a careful long-term follow-up should be continued for patients with multiple coronary artery aneurysms of doubtful origin. ( info) |
7/120. Pediatric autoimmune cardiovascular disease. Pediatric autoimmune cardiovascular disease can cause serious, sometimes life threatening sequelae on the pediatric population. Valvular, myocardial, and pericardial involvement causing morbidity and mortality can occur in association to rheumatic heart disease, systemic lupus erythematosus, and juvenile rheumatoid arthritis. Serious and potentially life threatening coronary artery involvement can occur in patients with childhood polyarteritis nodosa, takayasu arteritis, and Kawasaki disease. ( info) |
8/120. Perforated gastric ulcer complicating corticosteroid therapy in acute rheumatic fever. We report an 11-year-old boy with acute rheumatic fever who presented with gastric perforation while treated with corticosteroids (CS). He had been treated initially with acetylsalicylic acid for 11 days, CS replaced the treatment with acetylsalicylic acid due to deterioration of carditis. The possible pathogenesis is discussed. ( info) |
| Rheumatic chorea is the sole neurologic manifestation of rheumatic fever. It is a debilitating illness lasting for weeks to months. Drugs like diazepam, haloperidol, chlorpromazine take four to six weeks for functional improvement and can cause serious side effects. The authors investigated the role of vitamin e in reducing rheumatic chorea. A case series of patients of rheumatic chorea were administered vitamin e in the dose 50 IU daily for fifteen days. The various clinical signs of rheumatic chorea were scored with MAIMS score (Modified Abnormal Involuntary movement Scale score) which is used for tardive dyskinesia. No other drug for abnormal movements was used. In all the 4 patients who received vitamin e, there was remarkable change by 7th day and almost complete functional improvement by 14th day. vitamin e is safer than the conventional drugs used for chorea in children. It was found effective in this case series. Its role needs further evaluation by a double-blind randomized controlled trial. ( info) |
10/120. arthritis as a rare extra-intestinal manifestation of acute sigmoid diverticulitis. BACKGROUND: A causal association between acute diverticulitis of the sigmoid colon and arthritis has rarely been reported. CASE REPORT: We report the case of a 60-year-old patient who developed migrating arthritis of the knee and ankle during the recurring episode of acute diverticulitis of the sigmoid colon. Treatment with NSAIDs and antibiotics had little effect on joint disease, but medical treatment was successful in reducing the diverticulitis-related symptoms. arthritis promptly improved after surgical resection of the sigmoid colon, and 30 months later the patient is free of symptoms in the previously affected joints. CONCLUSIONS: Five cases of diverticulitis-associated arthritis have been reported. The similar case reported here reconfirms that joint disease has a limited response to medical approaches. colon resection is recommended for patients with diverticulitis-associated arthritis which does not respond promptly to antibiotic therapy. ( info) |