• Satoshi Sato, Masako Chiyotanda, Tae Hijikata, Yu Ishida, Shingo Oana, Gaku Yamanaka, Hisashi Kawashima, and Kosuke Kubo.
• Department of Pediatrics, Tokyo Medical University, Tokyo, Japan. Electronic address: sato115@tokyo-med.ac.jp.
• J. Infect. Chemother. 2015 Aug 1; 21 (8): 610-2.

BackgroundAcute rheumatic fever (ARF) is an illness caused by group A streptococcus (GAS) infection, and remains the leading cause of acquired heart disease in worldwide. Distinguishing between ARF and septic arthritis may be difficult. This report describes a case of suppurative arthritis overlapping with ARF.Case PresentationA 4-year-old, previously healthy boy presented with fever and left leg pain. The level of anti-streptolysin O (ASO) was elevated. His throat swab cultures grew GAS, but none were detected in his synovial fluid. Magnetic resonance imaging revealed suspected arthritis and osteomyelitis. The patient was treated for septic arthritis, but was subsequently diagnosed with ARF, after the development of carditis.ConclusionThe clinical and laboratory features of ARF and suppurative arthritis demonstrate substantial overlap. Patients with an elevated ASO should undergo a careful cardiac examination for carditis associated with ARF by an echocardiogram.Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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