Unusual presentation of rheumatic fever in a 3-year-old child in the UK

A Case Report: Acute Rheumatic Fever or Something More?

Acute rheumatic fever (ARF) is an autoimmune response that may occur after a group A Streptococcus (GAS) infection. Subcutaneous nodules are considered a rare manifestation of acute rheumatic fever with an incidence of 0%-10%. We present a case study of a 13-year-old girl who presented to us with subcutaneous nodules and articular involvement described as a non-migratory polyarticular joint pain involving the small joints of the hands, wrist, elbows, knees, and ankles for three months with poor response to the non-steroidal anti-inflammatory drug (NSAID) Ibuprofen. Accompanied with the presence of carditis, the patient fulfilled three major and two minor criteria of the revised Jones criteria 2015. Therefore, a diagnosis of acute rheumatic fever was made. The child was asymptomatic on subsequent visits, and although the subcutaneous nodules subsided, she will continue to receive penicillin every month for five years. We describe the successful diagnosis and management of a patient with ARF.