Concurrent Severe Rheumatic Carditis and Idiopathic Nephrotic Syndrome in a Child: A Rare Case Report | Chapter 8 | Medical Science: Updates and Prospects Vol. 7

 

Background: Rheumatic carditis is a severe immune-mediated complication of group A beta-hemolytic streptococcal infection, while idiopathic nephrotic syndrome is the most common glomerular disease in childhood. The coexistence of rheumatic carditis and renal disease suggests a shared immunopathogenic mechanism related to streptococcal infection. However, the simultaneous occurrence of rheumatic carditis and idiopathic nephrotic syndrome in the same patient is exceptionally rare, with very few cases reported in the literature.

 

Aim: The study aims to present the case of a 5-year-old child presenting with severe rheumatic carditis associated with idiopathic nephrotic syndrome, highlighting the diagnostic challenges, therapeutic management, and possible immunological links between these two conditions.

 

Case Presentation: This chapter presents the case of a 5-year-old boy admitted for generalised oedema and respiratory distress following a recent episode of tonsillitis. Clinical evaluation and investigations revealed severe decompensated rheumatic carditis associated with idiopathic nephrotic syndrome. Echocardiography showed dilation of all four cardiac chambers, biventricular systolic dysfunction, and multiple valvular regurgitations. Laboratory findings revealed nephrotic-range proteinuria and hypoalbuminemia, with elevated antistreptolysin O titers. The patient was treated with systemic corticosteroids, diuretics, an angiotensin-converting enzyme inhibitor, and antibiotic therapy, including secondary prophylaxis with benzathine penicillin. The clinical course was favourable, with rapid resolution of oedema, improvement in respiratory symptoms, normalisation of cardiac findings, and complete disappearance of proteinuria within one month of treatment.

 

Conclusion: This case describes the first documented association of severe rheumatic carditis and idiopathic nephrotic syndrome in a pediatric patient. It highlights the potential for multisystem immune-mediated complications following streptococcal infection and underscores the importance of early recognition and appropriate management in pediatric patients. Owing to the single-case design, causal inferences and definitive conclusions regarding shared immunopathogenic mechanisms remain limited. Further investigations are warranted to clarify the mechanisms that may account for the coexistence of these two conditions.

 

 

Author(s) Details

Idrissa Maïga
Pediatric Department, Naomi Harris Mother and Child Hospital, Bongourou, Kayes, Mali and Department of Pediatrics, Gabriel Touré University Hospital, Bamako, Mali.

 

Brehima Traore
International NGO Muso, Bamako, Mali.

 

Mamady Camara
Kayes Reference Health Center, Mali.

 

Mamadou Diakite
Department of Pediatrics, Gabriel Touré University Hospital, Bamako, Mali.

 

Fatoumata N. Diarra
Pediatric Department, Naomi Harris Mother and Child Hospital, Bongourou, Kayes, Mali.

 

Aminata Sangaré
Pediatric Department, Naomi Harris Mother and Child Hospital, Bongourou, Kayes, Mali.

 

Yaya Traoré
Pediatric Department, Naomi Harris Mother and Child Hospital, Bongourou, Kayes, Mali.

 

N'diaye Sory Ibrahimaa
International NGO Muso, Bamako, Mali.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v7/7249