Case Report: Coexistence of acute post-streptococcal glomerulonephritis and rheumatic heart disease in a 9 years old girl

Background: Group A-haemolytic streptococcus (GAS), one of the most frequent pathogens in pediatric group causing various diseases, from acute pharyngitis (AP) to severe complication such as acute rheumatic fever (ARF) and acute post-streptococcal glomerulonephritis (APSGN). GAS, round gram positive bacteria typically form pairs or chains, was reported causing 1.78 million cases with 500.000 death due to its severe complication in 2005.

Case Illustration: A 9-year-old female patient came to emergency unit (ER) complained swollen face and legs since 5 days ago, accompanied by tea color urine and reduced frequency and volume of micturition. Patient also complained shortness of breath which getting worse since yesterday, easily fatigue and dizziness. Moreover her mother also admitted that her daughter had history of migratory joints pain 3 weeks before admission, with sore throat a month ago. Blood pressure was 110/70 mmHg, Ross score was 8. Physical examination showed puffy face, pretibial edema, heart auscultation we heard pansystolic murmur. Chest radiography showed cardiomegaly and congestive pulmonum while laboratory exam showed ASTO 200, urinalysis showed red color, cloudy clarity, protein 1+, erythrocyte 3+, leukocytes 1+, urinary microscopic examination: 30-40 erythrocytes, 8-12 leukocytes, electrocardiography showed sinus tachycardia, prolonged PR interval, right atrial enlargement, right ventricle hypertrophy with right axis deviation. Patient was diagnosed with APSGN, hypertension grade II and heart failure due to rheumatic heart disease.

Summary: APSGN and ARF rarely occur together, the coincidence might be due to streptococci with nephritogenic and rheumatogenic same strains. Early detection and treatment of GAS are crucial to prevent complications.