Infectious Disease Reports · Published 2026-07-27 · DOI 10.3390/idr18040079
Debora Agreiter, Stefan Fuchs, Franziska Marti
Background: Acute rheumatic fever (ARF) is a clinical syndrome triggered by <i>group A streptococcal</i> (<i>GAS</i>) infections and characterized by fever, carditis, and arthritis as its main manifestations. Diagnosis relies on the revised Jones criteria. We report a rare case of ARF diagnosed in Switzerland. Case Presentation: An 18-year-old woman presented to the emergency department five days after returning from a one-week stay in Egypt with intermittent fever and a transient sore throat, followed by migratory joint pain. Laboratory testing revealed leukocytosis, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Chest X-ray, urine analysis, and (travel-associated) pathogen-testing (<i>Epstein–Barr virus</i>, <i>Cytomegalovirus</i>, <i>human immunodeficiency virus</i>, <i>Malaria</i>, <i>Dengue</i>, <i>Zika</i>, <i>Chikungunya</i>) were unremarkable. Blood cultures remained negative. Initially, a viral respiratory infection was suspected and symptomatic treatment established. Days later the patient was re-evaluated due to persistent symptoms. Leukocyte count (Lc) and CRP further increased and subcutaneous nodules appeared. The antistreptolysin-O (ASO)-titer was elevated more than three times higher than the normal upper limit and proofed serological evidence of a preceding streptococcal infection (<i>GAS</i> throat culture had not been performed). ARF was diagnosed according to the Jones criteria. Treatment with amoxicillin and a high dose of acetylsalicylic acid (ASA) led to a rapid clinical improvement. Secondary prophylaxis with depot penicillin (benzathine penicillin G; 1.2 million units; once monthly) was initiated to prevent rheumatic heart disease. Conclusions: This case highlights a rare occurrence of ARF following travel to Egypt, with probable acquisition of <i>group A streptococcal</i> infection during the trip. It emphasizes consideration of ARF even in Western countries with low ARF-prevalence if clinical history is suggestive. Early recognition and initiation of antimicrobial and anti-inflammatory therapy is crucial to prevent cardiac involvement. To the best of our knowledge, this represents one of the first cases diagnosed in Switzerland in the past 20 years.
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Agreiter, D., Fuchs, S., Marti, F. (2026). A Rare Case of Acute Rheumatic Fever Diagnosed After Recent Travel Abroad. Infectious Disease Reports. https://doi.org/10.3390/idr18040079