Occurrence of Rheumatic Heart Disease and Acute Glomerulonephrtis in an African Child

Abstract

Rheumatic heart disease (RHD) and acute glomerulonephritis (AGN) rarely co-exist. Only a few occurrences have been reported in the literature with
none among blacks of African descent. We report a 13-year-old Nigerian girl who presented in our hospital with a 3-month history of cough, orthopnoea and breathlessness both on exertion and at rest and three weeks history of bilateral pitting oedema up to the sacrum from the foot. There was a previous history of feet swelling about 5 years prior to this presentation which resolved without hospitalization. There was associated raised jugular venous pressure and pan-systolic murmur radiating to the axilla with pulmonary accentuation. Blood pressure of 170/ 10mmHg at admission. Proteinuria and haematuria were 3+ and 2+ respectively at admission, however serum protein, albumin and triglyceride were within
normal range. Serum creatinine was on the upward trend from 491μmol/l at admission. Erythrocyte sedimentation rate was 45mm/hr. Urine output was between 0.3-1.1mls/kg/hr and oedema never really subsided. Echocardiography suggested rheumatic heart disease and mitral incompetence. In view of the presence of cardiac symptom and increased erythrocyte sedimentation rate with oedema, hypertension, azotaemia and previous history of body swelling, a suspicion of RHD and AGN is entertained. These remain rare combinations with few reports in the literature and in Blacks living in Sub Saharan Africa.