Acute rheumatic fever (ARF)

• It is a systemic, immune-mediated disease that is triggered by pharyngeal infection with group A streptococci (GAS).
• Fever, migratory polyarthritis, and carditis are the most common clinical manifestations.
• ARF is most frequent among 5–15 year olds with a declining incidence in adults.
• ARF affects the heart, it usually involves the endocardium, myocardium, and pericardium to varying degrees.
• Erythema marginatum occurs in less than 2% of patients.
• It is an erythematous, flat, serpiginous macular rash with pale central clearing.
• The rash usually occurs on the trunk and extremities and characteristically spares the face. The rash waxes and wanes and may be transient.
• A dose of benzathine penicillin or 10 days of oral penicillin or erythromycin is recommended.

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