Acute rheumatic fever and multiple drug hypersensitivity: a case report

Cindy Fahira; Ketut Suryana

doi:10.18203/2349-3933.ijam20260392

Authors

Cindy Fahira Departement of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
Ketut Suryana Department of Internal Medicine, Allergy-Clinical Immunology Services Unit, Wangaya General Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.18203/2349-3933.ijam20260392

Keywords:

Acute rheumatic fever, Drugs hypersensitivity, Graded challenges

Abstract

Acute rheumatic fever (ARF) is an autoimmune-mediated inflammatory disorder precipitated by infection with group A Streptococcus (GAS) infection. The underlying pathogenesis is attributed to molecular mimicry, wherein antibodies directed against GAS antigens cross-react with host tissues. Diagnosis is established based on clinical evaluation using the revised Jones criteria in conjunction with laboratory evidence of recent GAS infection. Management involves antibiotic therapy, anti-inflammatory agents, and long-term prophylactic strategies to prevent recurrence. One of the potential adverse effects associated with these pharmacologic agents is drug hypersensitivity reactions (DHR). The recommended diagnostic approach to DHR is a graded challenge by introducing drugs safely and optimally under a threshold dose until the usual daily dose is reached. In the present case, due to the patient’s documented history of multiple drug hypersensitivities, a graded drug challenge was performed to ensure medication tolerance and minimize the risk of hypersensitivity.

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