Overlooking Recurrent Acute Rheumatic Fever in Adulthood.

Acute rheumatic fever in an adult is a rare entity. We present a 29-year-old man of mixed ancestry, including Native Hawaiian and other Pacific Islander, who presented with a 6-week history of migratory polyarthralgia and fever with a recent history of purulent lower extremity wounds and a remote history of acute rheumatic fever in childhood. The diagnosis of recurrent acute rheumatic fever was confirmed by elevated Antistreptolysin-O titers and Anti-DNase B titers. This case presentation showcases a Native Hawaiian and other Pacific Islander with acute rheumatic fever in both childhood and adulthood following pyoderma infection, with a delay in diagnosis and management for both episodes. The patient had an excellent response to naproxen without developing complications and was restarted on secondary antibiotic prophylaxis. Health care providers in the Pacific region should understand the relationship between pyoderma and acute rheumatic fever in addition to including acute rheumatic fever in the differential diagnosis of polyarthralgia in an adult.