Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of recent pharyngitis (approx. 2-4 weeks prior). Current symptoms include migratory polyarthritis involving large joints, fever, and signs of carditis (chest pain, dyspnea, or palpitations). Parent reports involuntary jerky movements (chorea) or skin changes (erythema marginatum/subcutaneous nodules).
Clinical Examination Findings
Vitals: Febrile, tachycardia. Cardiac: New or changing heart murmur (mitral/aortic regurgitation), friction rub, or signs of heart failure. Musculoskeletal: Swelling, erythema, and tenderness of large joints (migratory pattern). Neurological: Presence of Sydenham's chorea (rapid, purposeless movements). Skin: Erythema marginatum (annular, non-pruritic rash) or subcutaneous nodules over bony prominences.
Treatment Protocol
1. Eradication of Group A Streptococcus: Penicillin G benzathine IM or oral Penicillin V/Amoxicillin. 2. Anti-inflammatory: High-dose Aspirin or Naproxen for arthritis. 3. Corticosteroids: Indicated if severe carditis is present. 4. Heart Failure Management: Diuretics, ACE inhibitors, and fluid restriction as needed. 5. Secondary Prophylaxis: Long-term antibiotic therapy to prevent recurrence.