Major manifestations of Acute Rheumatic Fever
Carditis (50%–70%): Pericardium, myocardium, and valves may be involved. The mitral valve is most often affected, followed by the aortic valve. Echocardiography often shows involvement not appreciated clinically. Congestive heart failure from myocarditis occurs in 5% to 10% of patients, never occurs without valve involvement, and occurs more commonly in recurrences of ARF. All degrees of heart block can occur.
Subcutaneous nodules (<10%): These are usually associated with severe carditis but not arthritis. They are firm, painless, a few millimeters to 2 cm in size, and often resolve within days.
EM (<10%): EM is an irregular, serpiginous, nonpruritic rash that spreads centrifugally to the arms and trunk (never the face). Strongly associated with carditis.
Fever can be high, especially in the 1st week. However, in up to 30% of patients, the body temperature does not exceed 38°C. Fever does not last longer than 4 weeks.
