Rheumatic Fever: The Daily PANCE Blueprint
A 10-year-old boy is brought to the clinic due to recent onset of involuntary jerking movements of his limbs and face, which have been worsening over the past week. His parents mention that he had a sore throat and fever three weeks ago that resolved on its own. On examination, he exhibits a pericardial friction rub, and his ECG shows a prolonged PR interval along with nonspecific ST-segment changes. His erythrocyte sedimentation rate (ESR) is elevated. What is the most likely causative organism for this child's symptoms?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Streptococcus pyogenes
D. Haemophilus influenzae
E. Mycoplasma pneumoniae
Answer and topic summary
The answer is C. Streptococcus pyogenes
The presentation of involuntary movements, known as Sydenham’s chorea, along with recent history of pharyngitis and evidence of carditis (as indicated by pericardial friction rub and prolonged PR interval), strongly suggests rheumatic fever. Rheumatic fever is an autoimmune reaction that can occur following an infection with Streptococcus pyogenes, also known as Group A Streptococcus. This condition can lead to inflammation in the heart, joints, skin, and central nervous system, with Sydenham’s chorea and carditis being significant clinical manifestations.
Incorrect Answers:
- A. Streptococcus pneumoniae – While this bacterium can cause pneumonia and other respiratory infections, it is not typically associated with the development of rheumatic fever or Sydenham’s chorea.
- B. Staphylococcus aureus – This bacterium is a common cause of skin infections, abscesses, and bacteremia, but it is not a known cause of rheumatic fever or Sydenham’s chorea.
- D. Haemophilus influenzae – This bacterium can cause respiratory tract infections and invasive diseases like meningitis, but it does not cause rheumatic fever.
- E. Mycoplasma pneumoniae – This is a common cause of atypical pneumonia, especially in children and young adults, but it is not associated with rheumatic fever or the symptoms described in this case.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ ⇒
Also covered as part of the Pediatric EOR, and Internal Medicine EOR topic lists
