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Rheumatic pneumonia (RP) is a well described and poorly understood complication of acute rheumatic fever (ARF). It has been reported for more than a century and it has been traditionally associated with a high mortality rate. However, the existence and specificity of primary pulmonary lesions has remained controversial, because similar features may be seen in ARF with complicating congestive failure or uraemia.1 ,2 We report a case of RP that was successfully treated with steroids.
An 18 year old man was admitted to our hospital because of a 10 day history of fever, malaise, and dry cough. The patient had had ARF with carditis at age 7, which resolved without sequels. A tonsillectomy was performed three years later. Since then, he had received a benzathine penicillin G injection monthly until three years before his actual admission. On admission, physical examination disclosed a temperature of 38.5°C, respiratory rate of 26/min, and rales were heard at the left lower lung. The rest of the examination was unremarkable.
Laboratory values were white blood cells 14.3×109/l, with 80% neutrophils and 9% band cells, haemoglobin 132 g/l, and platelets 410×109/l. …