A 6 year old child comes to the clinic with 2 day history of fever, acute abdominal pain, and mild joint swelling. The child’s mom states that he had some type of sore throat recently and was treated successfully with some antibiotics. Upon physical exam, the patient had a temperature of 102 F with a new onset heart murmur. There was no evidence of joint edema, warmth, erythema, or tenderness at the time of the visit. Of the following, what would you least likely see in this patient.
A. Leukocytosis with increased PMN
B. Normocytic, normochromic anemia
C. Increased erythrocyte sedimentation rate
D. Positive throat culture for Streptococcus
E. Elevated serum titer of antistreptolysin O.
In this scenario, the patient is likely suffering from rheumatic fever, a condition that can follow streptococcal throat infection. The least likely finding in this case would be:
D. Positive throat culture for Streptococcus
By the time rheumatic fever develops, the acute throat infection usually would have been treated, and the throat culture might no longer show active infection. The other options are consistent with the typical findings in rheumatic fever.