APCU25MPB3 A double hit: acute rheumatic fever on chronic rheumatic heart disease with systemic thrombosis

Introduction Acute rheumatic fever (ARF) is a nonsuppurative complication of group A streptococcal (GAS) pharyngitis. It primarily affects the heart, joints, skin, and central nervous system, with rheumatic carditis carrying the most serious prognostic implications.Case Presentation A 40-year-old man with a history of childhood heart disease presented with one month of fever and sudden abdominal pain. Examination revealed a pansystolic murmur loudest at the mitral area. CT angiography showed acute thrombosis of the left renal and splenic arteries with infarctions. Echocardiography demonstrated moderate mitral regurgitation and mitral stenosis with thickening of the posterior mitral leaflet. ECG revealed atrial fibrillation. Laboratory tests showed elevated anti-streptolysin O titre (400), CK-MB (6.9; normal