Issue 3/2026
Vasilev, T., Temelkova, K., Stefanov, St., Dasheva-Dimitrova, A., Kibarova-Hristova, D.
Clinic of Rheumatology, Children’s Hospital „Ivan Mitev” – Sofia
Department of Pediatrics, Medical University – Sofia
Acute rheumatic fever is an immune-mediated complication of group A beta-hemolytic streptococcal infection which, despite its markedly reduced incidence in developed countries, remains a relevant diagnostic challenge in contemporary clinical practice. The disease increasingly presents with atypical and incomplete manifestations, including joint involvement with minimal inflammatory activity and subclinical cardiac involvement.
This article presents a clinical case of a 7-year-old child with arthritis and evidence of a recent streptococcal infection, in whom echocardiography played a decisive role in establishing the diagnosis. The differential diagnosis between acute rheumatic fever, poststreptococcal reactive arthritis, and juvenile idiopathic arthritis is discussed, with emphasis on practical diagnostic criteria and the importance of early detection of carditis.
The aim of this publication is to highlight that rheumatic fever should not be regarded solely as a historical condition but as a current clinical reality requiring a high index of suspicion among general practitioners. Early diagnosis and appropriate follow-up are essential to prevent long-term complications of rheumatic heart disease.
Key words: acute rheumatic fever, rheumatic heart disease, group A streptococcus, carditis
Address for correspondence:
Teodor Vasilev, MD, PhD
Clinic of Rheumatology,
Children’s Hospital “Ivan Mitev” – Sofia
11, Аcad. Ivan Geshov, Blvd.,
1612, Sofia
e-mail: tvasilev@medfac.mu-sofia.bg