Document Type : Case Report

Authors

1 Associate Professor, Department of Cardiology, Ganesh Shankar Vidyarthi Memorial Medical College, LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

2 Senior Registrar, Department of Cardiology, Ganesh Shankar Vidyarthi Memorial Medical College, LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

3 Assistant Professor, Department of Cardiology, Ganesh Shankar Vidyarthi Memorial Medical College, LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

4 Department of Cardiology, Ganesh Shankar Vidyarthi Memorial Medical College, LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

Abstract

BACKGROUND: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are the leading causes of acquired diseases in children and young adults in developing countries carrying considerable morbidity and mortality.Rheumatic fever (RF) commonly affects children between 5-15 years old and is rarely seen in < 5 years old. Mitral stenosis (MS) is the most common sequela, as it bears maximum onslaught. In India, few patients follow an unusually rapid course in developing severe MS because of its fulminant nature following attack of ARF.CASE REPORT: Our patient was a 28-month-old girl who had developed severe MS, mitral regurgitation (MR), and pulmonary hypertension (PH) as the sequelae of ARF which she had suffered at the age of 18 months old.CONCLUSION: To the best of our knowledge, this is the youngest reported case of rheumatic MS following ARF after extensive search in the literature. This case highlights the fact that very young population is not immune to ARF contrary to prior belief and therefore, more stringent preventive measures need to be implemented for it and possibility of ARF should be kept in mind while evaluating carditis in a child.

Keywords

  1. Tani LY, Veasy LG, Minich LL, Shaddy RE. Rheumatic fever in children younger than 5 years: Is the presentation different? Pediatrics 2003; 112(5): 1065-8.
  2. Stollerman GH. Rheumatic fever in the 21st century. Clin Infect Dis 2001; 33(6): 806-14.
  3. Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011; 3: 67-84.
  4. Roy SB, Bhatia ML, Lazaro EJ, Ramalingaswami V. Juvenile mitral stenosis in India. Lancet 1963; 2(7319): 1193-5.
  5. Reale A, Colella C, Bruno AM. Mitral stenosis in childhood: Clinical and therapeutic aspects. Am Heart J 1963; 66: 15-28.
  6. Bhayana JN, Khanna SK, Gupta BK, Sharma SR, Gupta MP, Padmavati S. Mitral stenosis in the young in developing countries. J Thorac Cardiovasc Surg 1974; 68(1): 126-30.
  7. Sarkar A, Patil S, Ahmed I. Balloon mitral valvotomy in youngest documented rheumatic mitral stenosis patient. Catheter Cardiovasc Interv 2015; 86(5): E213-E216.