Ischemic Stroke: an Unusual Presentation of Acute Rheumatic Fever

Case Report A Caucasian 8-year old boy was referred to our emergency room for recent-onset weakness on the right side of the body. During the previous months he had two febrile episodes lasting four days each, accompanied by arthralgia of elbows, knees and wrists, with no signs of inflammation. Family history was unremarkable. Physical examination showed mucocutaneous pallor, a few erythematous round cutaneous lesions on the buttocks and the inner thighs, and a 2/6 systolic murmur on the apex of the heart. He also appeared to be very asthenic and complained of migratory arthralgia on the lower limbs, without joint effusion. Blood tests showed high levels of inflammatory markers (Erythrocyte) sedimentation rate (ESR): 68 mm/h; C-reactive protein (CRP): 5.73 mg/dl) and a mild anaemia, with haemoglobin (Hb) at 10.9 g/dl. Abstract