Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Rheumatic Fever
Forum: The Heart Forum
Topic Area: Coronary Heart
Posted by CCF CARDIO MD-APS on March 07, 1999 at 07:59:06:
In Reply to: Rheumatic Fever posted by Freehardt on March 06, 1999 at 21:02:36:


My question is in regard to Rheumatic Fever. My 13 year old daughter has experienced 3 episodes of strep throat in the last year. She had a rash which started on her leg which looked like a large ringworm becasue of the red borders. She experienced no itching, This rash began spreading to other portions of her leg and then to both legs. She tells me that she had the initial ringlike rash on her leg for two months. As the rash spread I considered that it was ringowrm and bought Lotrimin. I saw very little improvement and then three weeks later the rash started to clear. Does the erythema marginatum rash of Rheumatic fever clear? My daughter also complains of migratory joint pains but there are no nodules on any joints. The most disoconcerting occurence happened last night. My daughter was out of town on a church retreat and she told me last night she experienced an episode of chest pain which lasted about four minutes. I am concerened about Rheumatic fever. She went to see her pediatrician three weeks ago with the latest episode of strep throat and was treated for two weeks with Augmentin. But I am wondering if she could have had strep a few months ago undetected and that led to the rash, joint pains etc. What are the diagnostic criteria for Rheumatic fever? What should I ask the pediatricin to evaluate? I did express my concern about Rheumatic fever at our last office visit and he assured me that is was rare. Again, the rash and the clinical picture I am now seeing worry me.

Thank You for your time and expertise.
I will look for a response on the bulletin board or feel free to Email me.

Thank you again


Dear Freehardt,
It is true that rheumatic fever is uncommon, most especially in those treated for their strep infections with antibiotics.

HAS LYME'S DISEASE EVER BEEN CONSIDERED? THIS IS THE DIAGNOSIS I THINK OF IN READING YOUR DESCRIPTION AND I WONDER, DID ANY PHYSICIAN SEE THIS RASH SOME TIME AGO?

The diagnostic criteria for rheumatic fever are called the "Jones criteria" and are classified as major and minor criteria. Major criteria include: carditis, erythema marginatum and subcutaneous nodules, Sydenham's chorea, and arthritis. The minor criteria include: fever, polyarthralgias, reversible prolongation of the PR interval, rapid ESR, evidence of anticedent beta-hemolytic streptococcal infection or a history of rheumatic fever.
The presence of two major and one minor criterion establish the diagnosis.

Because of the chest pain (along with the preceeding symptoms) your daughter would benefit from seeing a childrens cardilogist at the nearest children's hospital (usually only found at major university centers in the major cities.)
As well, a pediatric rheumatologist would be very helpful in sorting out whether or not there is a problem or not. We have a great staff of pediatric cardilogists and rheumatologists here at the Cleveland Clinic Childrens Hospital, who evaluate cases like your daughter on a fairly regular basis.

Most rashes do clear (that of lymes disease especially) and that is why it is very important for you to be there when the specialist asks about it.

I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!

If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
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cardiac problem.

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