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Symptoms And Treatment Of Acute Rheumatic Fever

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A 12 year old boy presents to urgent care with knee swelling and pain. On review of the record, he was seen and diagnosed with strep pharyngitis a month ago. On further questioning, mother admits she was unable to fill his prescription for amoxicillin, but his throat symptoms resolved. History reveals migratory arthritis, intermittent fevers up to 102oF. On physical exam, there are no oral lesions, neck is supple and there is a soft diastolic murmur. His right knee has a small effusion. Which of the following streptococcal complications has likely occured?

A: Acute rheumatic fever
• The reason this is the answer is because acute rheumatic fever is a complication that can occur post strep. In order to be diagnosed with rheumatic fever, a person must have a history of strep infection, plus at least one of the major and 2 minor or two majors. The criteria is known as the Jones criteria. The major symptoms are carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. The minor criteria include a fever, arthralgia, previous history of disease, acute phase reactions, and prolonged QT interval.
• https://www.uptodate.com/contents/acute-rheumatic-fever-clinical-manifestations-and-diagnosis?source=search_result&search=rheumatic%20fever&selectedTitle=1~119#H3
B: Glomerulonephritis
C: Scarlet fever D: Septic arthritis
• Septic arthritis is also known as infectious arthritis and is normally caused by a bacteria or fungus that is caught in a larger joint, such as

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