Recurrent Rheumatic Carditis Presenting With Severe Biventricular Dysfunction Despite a Normally Functioning Mechanical Mitral Valve.

BACKGROUND

Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity in endemic regions. Recurrence of acute rheumatic fever (ARF) in adults, especially after valve surgery, is rare but clinically significant.

CASE SUMMARY: A 44-year-old man with rheumatic mitral stenosis underwent mechanical mitral valve replacement. He presented 5 years later with dyspnea, orthopnea, and fatigue. Echocardiography showed new severe biventricular systolic dysfunction (left ventricular ejection fraction 20%) with preserved prosthetic function. Coronary computed tomography angiography excluded obstructive disease, and pulmonary embolism was ruled out. Elevated inflammatory markers raised suspicion for recurrent rheumatic carditis. He received anti-inflammatory therapy and guideline-directed medical therapy for heart failure, with progressive recovery.

DISCUSSION: Recurrent ARF should remain a diagnostic consideration in adults with prior RHD and new ventricular dysfunction, even after valve replacement.

TAKE-HOME MESSAGES: Recurrent ARF may occur post-surgery and cause myocardial dysfunction. Echocardiography and multimodality imaging are essential for diagnosis and management.