Recurrence of rheumatic fever after valve replacement is considered rare, and its recognition in adults poses significant diagnostic challenges, particularly in differentiating it from prosthetic valve–related complications such as infective endocarditis. We report a case of a middle-aged adult with rheumatic heart disease who had previously undergone double valve replacement with mechanical prostheses for severe mitral and aortic regurgitation. Several years after surgery, following discontinuation of secondary penicillin prophylaxis, the patient presented with fever and migratory inflammatory polyarthritis. Laboratory evaluation revealed markedly elevated inflammatory markers and antistreptolysin O titers, while electrocardiography demonstrated PR interval prolongation. Echocardiography showed normally functioning prosthetic valves without features of infective endocarditis. The patient fulfilled the modified Jones criteria for recurrent rheumatic fever and responded well to anti-inflammatory therapy, with subsequent normalization of electrocardiographic changes. Secondary penicillin prophylaxis was reinitiated with good clinical response. This case highlights that valve replacement does not eliminate susceptibility to recurrent rheumatic fever and underscores the importance of lifelong secondary prophylaxis in patients with rheumatic heart disease, particularly in endemic regions. Awareness of this entity is essential to avoid misdiagnosis and ensure appropriate long-term preventive strategies.

Muzamil Yousuf Lone is an Department of Cardiology at Sree Chitra Tirunal Institute for Medical Sciences and Technology.