Rheumatic Fever in a child

My son is 13 years old.  He became sick in June with a sore throat and fever.  He then starting having symptons of chest pains, muscle aches/cramps, joint pain that moved from jt. to jt., with no redness or swelling that we noticed.  He had shortness of breath and wheezing, that was treated as exercise induced ashtma ( He runs cross country).  We never noticed a rash.  He had extreme fatigue and would fall asleep at school.  We went to the ER one night and they put him on an antibiotic for bronchiolitis.  Throughout all this we regularly visited our family physician and he ran several blood tests and had echo's done.  His echo came back that he had some I believe mitral valve leakage, but everything else was okay.  His ASO titre came back at 640 and his ANA was positive. Our family physician treated him for rheumatic fever with a penicillin injection, until we saw the cardio. Based on the fact that he did not have joint swelling, a rash and no carditis he was not diagnosed with rheumatic fever. We also saw a rheumotologist.  My question is could the Antibiotics from the ER have masked any symptons of rheumatic fever?  We are not treating him for anything.  His ASO  titres continue to remain high arond 550.  I am concerned he will turn up with heart trouble down the road. I am concerned that he may have had mild rheumatic fever.  Thank you for any advice you can give us.  He continues to have some fatigue, mucsle cramping at times and occasional jt. pain.  He will occasionally complain that his chest and around his back hurts.

[Cleveland Clinic]

TLM,

thanks for the post. I'm sorry to hear of your son's recent illness. As a parent, I realize how taxing these things can be.

I'm not a pediatrician so I do not feel overly comfortable giving you too much guidance.

Rheumatic fever is actually an inflammatory condition that is brought on as the body's reaction to streptococcal infection. Actually, early treatment of strep tends to decrease the incidence that it deveops. Early treatment of his symptoms in the ED would have mostly likely have been beneficial.

We dont tend to see rheumatic fever very often. Ive seen less than 10 cases in the last 10 years and all of my time is spent in tertiary care centers.

There are many conditions which could possibly cause your sons symptoms. I would recommend seeing a pediatrician or a pediatric rheumatologist in a tertiary referral center for further evaluation or second opinion.

good luck

[TLM61]

I forgot to ask also what would make his ASO titres to stay high? Thanks.