Brief Answer: Primary care doctor , no serious worries for rheum Detailed Answer: Hi and thanks for the query, The symptoms he presents with at this point in time do not actually demand that you should be so concerned with rheumatic fever. It is a possible complication, but very unlikely within the present clinical state, and symptoms he presents with. No worries at this point in time with respect to rheumatic fever. However, extreme fatigue, pain in tail bone, nose bleeds and coughing could demand an in depth clinical review. It might be of utmost importance to note any history of excessive bleeding in his history, of if this is the very first time he presents with such symptoms. It is not however rare to be tired after an illness, bacterial or viral. I would suggest a complete blood count to carefully check his hemoglobin level to exclude any serious anemia, may be due to blood loss that could explain this fatigue. Onset of chest pain could imply a lung infection. A history of gastritis, under conditions of stress as such could also explain chest pain. A complete clinical review, and a chest X ray, based on the clinical findings, could throw more light to what is actually going on with his health condition. I strongly suggest a consultation with his primary care doctor. A complete blood count, chest X ray coupled with proper clinical review would be most useful. Checking for onset of rheumatic fever could be helpful, but its not very likely, though possible under circumstances and symptoms he presents with. Thanks and kind regards. Please, do feel free asking further questions in case you got any specific concerns. I would be glad to contribute as I wish him the best of health. Dr Bain

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