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
The correct answer is (D) Positive throat culture for Streptococcus.
The patient’s symptoms and physical exam findings suggest a diagnosis of Acute Rheumatic Fever (ARF), a complication of untreated or inadequately treated Group A Streptococcal (GAS) pharyngitis.
The patient’s recent history of sore throat and successful treatment with antibiotics suggests that the initial streptococcal infection has been cleared. Therefore, a positive throat culture for Streptococcus would be unlikely.