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Patient History and Symptoms
RV is a 10-year-old black male patient brought to the hospital by his parents because the boy had pain and redness in his knees, elbows, and wrists during the past several days. His parents recently immigrated to the United States from Ghana and have still not adapted well to the new medical system. Thus, when their son had a fever and a sore throat, they gave him antipyretics and decided not to see a doctor. According to his past medical history, there were no chronic illnesses, surgeries, or other hospitalizations. The boy has no known allergies, and his immunizations are up-to-date.
Diagnostic Findings and Treatment
Physical examination showed arthralgia bilaterally in all large joints, as well as mild mitral regurgitation, which was revealed during heart auscultation. In fact, severe mitral regurgitation in these patients occurs only in 10-30% of patients (Karthikeyan & Guilherme, 2018). Figure 1 shows the diagnostic findings of echocardiography, which confirmed rheumatic heart disease in this patient. However, no apparent signs of heart failure were present during the examination. No other elements of the JONES criteria were present except carditis and joint pain. Therefore, the treatment will focus on eradicating the infectious agent, Streptococcus pyogenes, that caused this autoimmune condition and managing arthralgia (Wallace, 2021). This patient will be recommended to take oral amoxicillin, 40 mg/kg, for ten days for the infection (Karthikeyan & Guilherme, 2018). Additionally, 100 mg/kg of aspirin should be taken for four weeks for joint pain in combination with a proton pump inhibitor for gastric protection.
References
Ali, F., Hasan, B., Ahmad, H., Hoodbhoy, Z., Bhuriwala, Z., Hanif, M., Ansari, S. U., & Chowdhury, D. (2021). Detection of subclinical rheumatic heart disease in children using a deep learning algorithm on digital stethoscope: a study protocol. BMJ Open, 11(8), 1-7. Web.
Karthikeyan, G., & Guilherme, L. (2018). Acute rheumatic fever. The Lancet, 392(10142), 161-174. Web.
Wallace, M. R. (2021). Rheumatic fever. Medscape. Web.
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