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I read recently in the Annals a letter by Fuente et al on rheumatic pneumonia.1 Despite the authors stating that they had completely reviewed Spanish and English publications, an article by us published in 1995 was not included.2
Our article would have added to the information contained in the letter by Fuente et al because it described the case of a 3 year old girl (an uncommon age for the onset of rheumatic disease), in whom arthritis and carditis occurred together, with valvular sequelae (mitral insufficiency) that required surgical intervention a year later.
In Pernambuco, in the northeast of Brazil, which has serious socioeconomic problems, rheumatic fever is endemic among the poor, particularly in children and adolescents, causing early damage to mitral and aortic valves. Rheumatic pneumonia, though uncommon, can be seen in about 2% of our acute cases, mostly recurrent, with severe concomitant valvulitis.
We thank Dr Saraiva for his letter and think that the case reported1 is very interesting as they describe rheumatic pneumonia associated with mitral insufficiency at an unusually early age of onset in a region where rheumatic fever continues to be prevalent. This emphasises even more the rarity of this complication.
Unfortunately, we were unable to include the article in our review because it was not indexed in the bibliographic sources we used (Medline, Medline plus, and PubMed of the United States National Library of Medicine databases) and it was not referred to in the bibliography of papers reviewed in our article.