Rheumatic Fever: The Daily PANCE Blueprint

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Rheumatic Fever: The Daily PANCE Blueprint

A 12-year-old male is brought into the clinic complaining of his joints hurting and slight chest discomfort. His vitals are remarkable for a fever (T 101.4F). On physical exam, you note superficial nodules along his legs. Labs reveal leukocytosis and elevated ESR. He says just a few weeks ago he had a bad “sore throat” that went away. Which of the following is the treatment of choice for the most likely diagnosis?

A. Doxycycline
B. Acyclovir and steroids
C. Erythromycin
D. Clindamycin
E. Penicillin V

Answer and topic summary

The answer is E. Penicillin V

Acute rheumatic fever is an inflammatory response that usually happens a few weeks after an untreated group A streptococcus infection (Streptococcus pyogenes). It impacts the joints, hearts, skin, and central nervous system. The Jones criteria is used for diagnosis. Major criteria include: JONES aka Joint involvement, myOcarditis, Nodules (subcutaneous), Erythema marginatum, and Sydenham chorea. Minor criteria include: CAFEPAL aka CRP increased, Arthralgia, Fever, Elevated ESR, Prolonged PR interval, Anamnesis of rheumatism, and Leukocytosis. 1st line management is penicillin V.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Bacterial Disease ⇒ Rheumatic fever

Also covered as part of the Internal Medicine EOR and Pediatric EOR and topic lists

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