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Rare Symptoms

Erythema marginatum

  • Highly specific to ARF

  • Cutaneous lesion: reddish pink borderpale centreround or irregular shape

  • Often on trunk, abdomen, inner arms or thighs

  • Highly suggestive of carditis











Subcutaneous nodules

  • Usually 0.5-2cm in diameter: Firm, non-tender, isolated or in clusters

  • Most common along on the extensor surfaces of the joint: knees, elbows, wrist

  • Also on bony prominences, tendons, dorsi of feet, occiput or cervical spine.

  • Last a few days only

  • Often associated with carditis 







Sydenham’s Chorea

  • Extrapyramidal disorder: 

  • Fast, clonic involuntary movements (especially face and limbs)

  • Muscular hypotonus

  • Emotional lability

  • First sign: difficulty walking, talking, writing

  • Usually a late manifestation, can be months after infection

  • May be the only manifestation of ARF

  • Often associated with carditis

  • Usually benign and resolves in 2-3 months

  • But can last for more than 2 years

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