TY - CHAP M1 - Book, Section TI - Acute Rheumatic Fever A1 - Bongartz, Timothy A1 - Dingle, Jodi A. A2 - Knoop, Kevin J. A2 - Stack, Lawrence B. A2 - Storrow, Alan B. A2 - Thurman, R. Jason PY - 2021 T2 - The Atlas of Emergency Medicine, 5e AB - Acute rheumatic fever is a postinfectious complication of group A Streptococcus tonsillopharyngitis. Clinical signs can include migratory polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea (the five major diagnostic criteria). Arthritis is the most common manifestation, which can be distinguished from other rheumatologic or infectious conditions by its tendency to affect large joints. The migratory pattern is also characteristic and less commonly seen in other conditions. Carditis is the next most common manifestation, often causing endocarditis and possible valvular damage. Subcutaneous nodules (located on extensor surfaces) and erythema marginatum (macular erythematous rash with serpiginous border, as pictured) are less commonly seen. Sydenham chorea presents with jerky, involuntary movements of the face and extremities. While the other major manifestations are typically seen 2 to 3 weeks after streptococcal pharyngitis, chorea can develop several months later. Diagnosis of rheumatic fever also requires evidence of preceding streptococcal infection, either by positive rapid strep test or evidence of elevated streptococcal antibody tiers (anti-streptolysin O [ASO] or anti-DNAse B). Diagnosis is made based on the presence of two major criteria (carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules) or one major and two minor criteria (fever, arthralgia [in absence of arthritis], elevated acute phase reactants, prolonged PR interval). SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/03/28 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1181053218 ER -