IMAGES IN CLINICAL MEDICINE
Acute Rheumatic Fever with Erythema Marginatum
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- A previously healthy 36-year-old man presented with a 1-month history of fever and pain in both shoulders and knees, which had been preceded by a sore throat 2 weeks before the onset of fever. Laboratory studies were notable for a white-cell count of 13,800 per cubic millimeter (85% neutrophils), a C-reactive protein level of 26 mg per deciliter (reference value, ≤0.3), and an antistreptolysin O titer of 1478 IU per milliliter (reference value, <241 10="" a="" abated="" abdomen="" administration="" after="" and="" anel="" annular="" antiinflammatory="" aortic="" appeared="" arthralgias="" before="" black="" course="" days="" diameter="" dots="" drug.="" echocardiography="" faded="" fever="" few="" forearm="" his="" hours="" href="http://www.nejm.org/doi/suppl/10.1056/NEJMicm1601782/suppl_file/nejmicm1601782_appendix.pdf" ig.="" in="" indicate="" ink="" later="" lesion="" lesions="" limbs="" macules="" migrated="" mild="" nbsp="" new="" nonpruritic="" nonsteroidal="" of="" on="" one="" over="" painless="" photograph="" rash="" red="" regurgitation.="" revealed="" right="" s1="" shows="" style="border: 0px; color: #006892; font-size: 13.008px; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" taken="" that="" the="" then="" time="" transthoracic="" upper="" was="" week="" while="" within="">Supplementary Appendix241>
Makoto Saito, M.D.
University of Tokyo Hospital, Tokyo, Japan
University of Tokyo Hospital, Tokyo, Japan
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